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Marnat G, Gerschenfeld G, Olindo S, Sibon I, Seners P, Clarençon F, Smadja D, Chausson N, Ben Hassen W, Piotin M, Caroff J, Alamowitch S, Turc G. Incidence and predictors of intracranial hemorrhage after intravenous thrombolysis with tenecteplase. Eur Stroke J 2024:23969873241253660. [PMID: 38757712 DOI: 10.1177/23969873241253660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Despite its increasing use, there are limited data on the risk of intracranial hemorrhage (ICH) after intravenous thrombolysis with tenecteplase in the setting of acute ischemic stroke. Our aim was to investigate the incidence and predictors of ICH after tenecteplase administration. METHODS We reviewed data from the prospective ongoing multicenter TETRIS (Tenecteplase Treatment in Ischemic Stroke) registry. Patients with available day-1 imaging were included in this study. Clinical, imaging and biological variables were collected. Follow-up imaging performed 24 h after IVT was locally reviewed by senior neuroradiologists and neurologists. The incidence of parenchymal hematoma (PH) and any ICH were investigated. Potential predictors of PH and any ICH were assessed in multivariable logistic regressions. Subgroup analyses focusing on patients intended for endovascular treatment were performed. RESULTS PH and any ICH occurred in 126/1321 (incidence rate: 9.5%, 95% CI 8.1-11.2) and 521/1321 (39.4%, 95% CI 36.8-42.1) patients, respectively. Symptomatic ICH was observed in 77/1321 (5.8%; 95% CI 4.7-7.2). PH occurrence was significantly associated with poorer functional outcomes (p < 0.0001) and death (p < 0.0001) after 3 months. Older age (aOR = 1.03; 95% CI 1.01-1.05), male gender (aOR = 2.07; 95% CI 1.28-3.36), a history of hypertension (aOR = 2.08; 95% CI 1.19-3.62), a higher baseline NIHSS (aOR = 1.07; 95% CI 1.03-1.10) and higher admission blood glucose level (aOR = 1.12; 95% CI 1.05-1.19) were independently associated with PH occurrence. Similar associations were observed in the subgroup of patients intended for endovascular treatment. CONCLUSION We quantified the incidence of ICH after IVT with tenecteplase in a real-life prospective registry and determined independent predictors of ICH. These findings allow to identify patients at high risk of ICH.
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Affiliation(s)
- Gaultier Marnat
- Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | - Gaspard Gerschenfeld
- Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, AP-HP, Hôpital Saint-Antoine, Sorbonne Université, Paris, France; STARE team, iCRIN, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | | | - Igor Sibon
- Neurology, Bordeaux University Hospital, Bordeaux, France
| | - Pierre Seners
- Neurology, Fondation Rothschild, Paris, Île-de-France, France
| | | | - Didier Smadja
- Unité Neuro-vasculaire, Hôpital Sud Francilien, Corbeil-Essonnes, France
| | - Nicolas Chausson
- Unité Neuro-vasculaire, Hôpital Sud Francilien, Corbeil-Essonnes, France
| | | | | | - Jildaz Caroff
- Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | - Sonia Alamowitch
- Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, AP-HP, Hôpital Saint-Antoine, Sorbonne Université, Paris, France; STARE team, iCRIN, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Guillaume Turc
- Neurology, GHU Paris Psychiatrie et Neurosciences, INSERM U1266, Université Paris Cité, FHU NeuroVasc, Paris, France
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Wang R, Liu Y, Zhang Q, Zhang J, Peng H, Shi M, Peng Y, Xu T, Wang A, Xu T, Chen J, Zhang Y, He J. Twenty-four-hour blood pressure trajectories and clinical outcomes in patients who had an acute ischaemic stroke. Heart 2024; 110:768-774. [PMID: 38569853 DOI: 10.1136/heartjnl-2023-323821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/19/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE The management of blood pressure (BP) in acute ischaemic stroke remains a subject of controversy. This investigation aimed to explore the relationship between 24-hour BP patterns following ischaemic stroke and clinical outcomes. METHODS A cohort of 4069 patients who had an acute ischaemic stroke from 26 hospitals was examined. Five systolic BP trajectories were identified by using latent mixture modelling: trajectory category 5 (190-170 mm Hg), trajectory category 4 (180-140 mm Hg), trajectory category 3 (170-160 mm Hg), trajectory category 2 (155-145 mm Hg) and trajectory category 1 (150-130 mm Hg). The primary outcome was a composite outcome of death and major disability at 3 months poststroke. RESULTS Patients with trajectory category 5 exhibited the highest risk, while those with trajectory category 1 had the lowest risk of adverse outcomes at 3-month follow-up. Compared with the patients in the trajectory category 5, adjusted ORs (95% CIs) for the primary outcome were 0.79 (0.58 to 1.10), 0.70 (0.53 to 0.93), 0.64 (0.47 to 0.86) and 0.47 (0.33 to 0.66) among patients in trajectory category 4, trajectory category 3, trajectory category 2 and trajectory category 1, respectively. Similar trends were observed for death, vascular events and the composite outcome of death and vascular events. CONCLUSION Patients with persistently high BP at 180 mm Hg within 24 hours of ischaemic stroke onset had the highest risk, while those maintaining stable BP at a moderate-low level (150 mm Hg) or even a low level (137 mm Hg) had more favourable outcomes.
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Affiliation(s)
- Ruirui Wang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Yang Liu
- Department of Cardiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Qilu Zhang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Jing Zhang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Hao Peng
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Mengyao Shi
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Yanbo Peng
- Department of Neurology, Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, China
| | - Tian Xu
- Department of Neurology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Aili Wang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Tan Xu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Jing Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Yonghong Zhang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
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3
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Agbonon R, Forestier G, Bricout N, Benhassen W, Turc G, Bretzner M, Pasi M, Benzakoun J, Seners P, Derraz I, Legrand L, Trystram D, Rodriguez-Regent C, Charidimou A, Rost NS, Bracard S, Cordonnier C, Eker OF, Oppenheim C, Naggara O, Henon H, Boulouis G. Cerebral microbleeds and risk of symptomatic hemorrhagic transformation following mechanical thrombectomy for large vessel ischemic stroke. J Neurol 2024; 271:2631-2638. [PMID: 38355868 DOI: 10.1007/s00415-024-12205-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/08/2024] [Accepted: 01/16/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND AND PURPOSE In patients with acute ischemic stroke (AIS) treated with endovascular therapy (EVT), the association of pre-existing cerebral small vessel disease (cSVD) with symptomatic intracerebral hemorrhage (sICH) remains controversial. We tested the hypothesis that the presence of cerebral microbleeds (CMBs) and their burden would be associated with sICH after EVT of AIS. METHODS We conducted a retrospective study combining cohorts of patients that underwent EVT between January 1st 2015 and January 1st 2020. CMB presence, burden, and other cSVD markers were assessed on a pre-treatment MRI, evaluated independently by two observers. Primary outcome was the occurrence of sICH. RESULTS 445 patients with pretreatment MRI were included, of which 70 (15.7%) demonstrated CMBs on baseline MRI. sICH occurred in 36 (7.6%) of all patients. Univariate analysis did not demonstrate an association between CMB and the occurrence of sICH (7.5% in CMB+ group vs 8.6% in CMB group, p = 0.805). In multivariable models, CMBs' presence was not significantly associated with increased odds for sICH (-aOR- 1.19; 95% CI [0.43-3.27], p = 0.73). Only ASPECTs (aOR 0.71 per point increase; 95% CI [0.60-0.85], p < 0.001) and collaterals status (aOR 0.22 for adequate versus poor collaterals; 95% CI [0.06-0.93], p 0.019) were independently associated with sICH. CONCLUSION CMB presence and burden is not associated with increased occurrence of sICH after EVT. This result incites not to exclude patients with CMBs from EVT. The risk of sICH after EVT in patients with more than10 CMBs will require further investigation. REGISTRATION Registration-URL: http://www. CLINICALTRIALS gov ; Unique identifier: NCT01062698.
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Affiliation(s)
- Rémi Agbonon
- Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
| | - Géraud Forestier
- Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France.
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France.
- Neuroradiology Department, Limoges University Hospital, 2 avenue Martin Luther-King, 87042, Limoges, France.
| | - Nicolas Bricout
- Neuroradiology Department, Univ. Lille, Inserm, CHU Lille, U1172-LilNCog (JPARC)-Lille Neurosciences & Cognition, 59000, Lille, France
| | - Wagih Benhassen
- Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
| | - Guillaume Turc
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
- Neurology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Martin Bretzner
- Neuroradiology Department, Univ. Lille, Inserm, CHU Lille, U1172-LilNCog (JPARC)-Lille Neurosciences & Cognition, 59000, Lille, France
| | - Marco Pasi
- Univ. Lille, Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience & Cognition, 59000, Lille, France
| | - Joseph Benzakoun
- Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
| | - Pierre Seners
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
- Neurology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Imad Derraz
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Laurence Legrand
- Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
| | - Denis Trystram
- Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
| | - Christine Rodriguez-Regent
- Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
| | - Andreas Charidimou
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Natalia S Rost
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Serge Bracard
- Neuroradiology Department, Lorraine University, INSERM U1254 CHRU Nancy, Nancy, France
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience & Cognition, 59000, Lille, France
| | - Omer F Eker
- Department of Neuroradiology of Pierre Wertheimer Hospital, Hospices Civils de Lyon, Lyon, France
| | - Catherine Oppenheim
- Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
| | - Olivier Naggara
- Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
| | - Hilde Henon
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
- Neurology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Grégoire Boulouis
- Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
- Neuroradiology Department, CHU de Tours, Centre Val de Loire Region, Tours, France
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Kakaletsis N, Ntaios G, Milionis H, Karagiannaki A, Chouvarda I, Dourliou V, Chytas A, Hatzitolios AI, Savopoulos C. Prognostic significance of 24-h blood pressure and variability indices in the outcome of acute ischaemic stroke. Intern Med J 2023; 53:1137-1146. [PMID: 35666577 DOI: 10.1111/imj.15834] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 05/29/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The association between blood pressure (BP) levels and BP variability (BPV) following acute ischaemic stroke (AIS) and outcome remains controversial. AIMS To investigate the predictive value of systolic BP (SBP) and diastolic BP (DBP) and BPV measured using 24-h ambulatory blood pressure monitoring (ABPM) methods during AIS regarding outcome. METHODS A total of 228 AIS patients (175 without prior disability) underwent ABPM every 20 min within 48 h from onset using an automated oscillometric device (TM 2430, A&D Company Ltd) during day time (7:00-22:59) and night time (23:00-6:59). Risk factors, stroke subtypes, clinical and laboratory findings were recorded. Mean BP parameters and several BPV indices were calculated. End-points were death and unfavourable functional outcome (disability/death) at 3 months. RESULTS A total of 61 (26.7%) patients eventually died. Multivariate logistic regression analysis revealed that only mean night-time DBP (hazard ratio (HR): 1.04; 95% confidence interval (CI): 1.00-1.07) was an independent prognostic factor of death. Of the 175 patients without prior disability, 79 (45.1%) finally met the end-point of unfavourable functional outcome. Mean 24-h SBP (HR: 1.03; 95% CI: 1.00-1.05), day-time SBP (HR: 1.02; 95% CI: 1.00-1.05) and night-time SBP (HR: 1.03; 95% CI: 1.01-1.05), SBP nocturnal decline (HR: 0.93; 95% CI: 0.88-0.99), mean 24-h DBP (HR: 1.08; 95% CI: 1.03-1.13), day-time DBP (HR: 1.07; 95% CI: 1.03-1.12) and night-time DBP (HR: 1.06; 95% CI: 1.02-1.10) were independent prognostic factors of an unfavourable functional outcome. CONCLUSIONS In contrast with BPV indices, ABPM-derived BP levels and lower or absence of BP nocturnal decline in the acute phase are prognostic factors of outcome in AIS patients.
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Affiliation(s)
- Nikolaos Kakaletsis
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Haralampos Milionis
- Department of Internal Medicine, Medical School, University of Ioannina, University Hospital of Ioannina, Ioannina, Greece
| | - Anastasia Karagiannaki
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Ioanna Chouvarda
- Laboratory of Medical Informatics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasiliki Dourliou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Achileas Chytas
- Laboratory of Medical Informatics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos I Hatzitolios
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
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Ramnarine IVP, Rasheed OW, Laud PJ, Majid A, Harkness KA, Bell SM. Thrombolysis Outcomes in Acute Ischaemic Stroke Patients with Pre-Existing Cognitive Impairment. Life (Basel) 2023; 13:life13041055. [PMID: 37109584 PMCID: PMC10141004 DOI: 10.3390/life13041055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/30/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Thrombolysis treatment for ischaemic stroke in patients with pre-existing disabilities, including cognitive impairment, remains controversial. Previous studies have suggested functional outcomes post-thrombolysis are worse in patients with cognitive impairment. This study aimed to compare and explore factors contributing to thrombolysis outcomes, including haemorrhagic complications, in cognitively and non-cognitively impaired patients with ischaemic stroke. MATERIALS AND METHODS A retrospective analysis of 428 ischaemic stroke patients who were thrombolysed between January 2016 and February 2021 was performed. Cognitive impairment was defined as a diagnosis of dementia, mild cognitive impairment, or clinical evidence of the condition. The outcome measures included morbidity (using NIHSS and mRS), haemorrhagic complications, and mortality, and were analysed using multivariable logistic regression models. RESULTS The analysis of the cohort revealed that 62 patients were cognitively impaired. When compared to those without cognitive impairment, this group showed worse functional status at discharge (mRS 4 vs. 3, p < 0.001) and a higher probability of dying within 90 days (OR 3.34, 95% CI 1.85-6.01, p < 0.001). A higher risk of a fatal ICH post-thrombolysis was observed in the cognitively impaired patients, and, after controlling for covariates, cognitive impairment remained a significant predictor of a fatal haemorrhage (OR 4.79, 95% CI 1.24-18.45, p = 0.023). CONCLUSIONS Cognitively impaired ischaemic stroke patients experience increased morbidity, mortality, and haemorrhagic complications following thrombolytic therapy. However cognitive status is not independently predictive of most outcome measures. Further work is required to elucidate contributing factors to the poor outcomes observed in these patients and help guide thrombolysis decision-making in clinical practice.
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Affiliation(s)
- Isabela V P Ramnarine
- Sheffield Institute of Translational Neuroscience, University of Sheffield, Glossop Road, Sheffield S10 2GF, UK
| | - Omar W Rasheed
- Sheffield Institute of Translational Neuroscience, University of Sheffield, Glossop Road, Sheffield S10 2GF, UK
| | - Peter J Laud
- Statistical Services Unit, University of Sheffield, Sheffield S10 2HQ, UK
| | - Arshad Majid
- Sheffield Institute of Translational Neuroscience, University of Sheffield, Glossop Road, Sheffield S10 2GF, UK
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2GJ, UK
| | - Kirsty A Harkness
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2GJ, UK
| | - Simon M Bell
- Sheffield Institute of Translational Neuroscience, University of Sheffield, Glossop Road, Sheffield S10 2GF, UK
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2GJ, UK
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6
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Time of blood pressure in target range in acute ischemic stroke. J Hypertens 2023; 41:303-309. [PMID: 36583356 DOI: 10.1097/hjh.0000000000003331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the association of blood pressure (BP) time-in-target range (TTR) derived from 24-h ambulatory BP monitoring (ABPM) during the acute phase of ischemic stroke (AIS), with the severity of stroke and its predictive value for the 3 months outcome. METHODS A total of 228 AIS patients (prospective multicenter follow-up study) underwent ABPM every 20 min within 48 h from stroke onset using an automated oscillometric device. Clinical and laboratory findings were recorded. Mean BP parameters, BP variability and TTR for SBP (90-140 mmHg), DBP (60-90 mmHg), and mean arterial pressure (MAP) were calculated. Endpoints were death and disability/death at 3 months. RESULTS A total of 14 942 BP measurements were recorded (∼66 per AIS patient) within 72 h of stroke onset. Patient's 24-h TTR was 34.7 ± 29.9, 64.3 ± 24.2, and 55.3 ± 29.4% for SBP, DBP and MAP, respectively. In patients without prior hypertension, TTR was lower as stroke severity increased for both DBP (P = 0.031) and MAP (P = 0.016). In 175 patients without prior disability, increase in TTR of DBP and MAP associated significantly with a decreased risk of disability/death (hazard ratio 0.96, 95% CI 0.95-0.99, P = 0.007 and hazard ratio 0.97, 95% CI 0.96-0.99, P = 0.007). TTR of SBP in 130-180 mmHg and 110-160 mmHg ranges seems to be related with mortality and disability outcomes, respectively. CONCLUSION TTR can be included for a more detailed description of BP course, according to stroke severity, and for the evaluation of BP predictive role, in addition to mean BP values, derived from ABPM during the acute phase of AIS. CLINICAL TRIAL REGISTRATIONURL http://www.clinicaltrials.gov. Unique identifier: NCT01915862.
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Pengtong W, Aimyong N, Nilanont Y. Intracranial Hemorrhage after Recombinant Tissue Plasminogen Activator: The competing risks survival analysis. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2023.101734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Jabłoński B, Gójska-Grymajło A, Ossowska D, Szurowska E, Wyszomirski A, Rojek B, Karaszewski B. New Remote Cerebral Microbleeds on T2 *-Weighted Echo Planar MRI After Intravenous Thrombolysis for Acute Ischemic Stroke. Front Neurol 2022; 12:744701. [PMID: 35242092 PMCID: PMC8886895 DOI: 10.3389/fneur.2021.744701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background The main and well-defined complication of intravenous administration of recombinant tissue plasminogen activator (tPA) in patients with acute ischemic stroke (AIS) is symptomatic intracranial hemorrhage (sICH). However, rtPA might also be connected with the formation of cerebral microbleeds (CMBs), located remotely from the ischemic lesions, that may remain clinically silent. This association might be important because the load of CMBs has been associated with cognitive impairment. We investigated whether administration of rtPA in AIS results in the appearance of new CMBs and if the initial load of CMBs is associated with hemorrhagic transformation. Methods A total of fifty-nine consecutive patients with AIS treated with rtPA underwent MRI including T2*-weighted Echo Planar Imaging (T2*-EPI) shortly before and 7–9 days after rtPA administration. We calculated the load of new CMBs located outside the MR diffusion restriction area in the follow-up imaging and assessed hemorrhagic transformation with ECASS-II scoring. Results A total of forty-nine patients were included for the final analysis. On initial T2*-EPI-GRE, 37 baseline microbleeds (CMBs) were observed in 14 patients (28.6%). On follow-up T2*-EPI-GRE amount of CMBs increased to a total number of 103. New CMBs were found in 5 (14.3%) of 35 patients without and in 9 (64.3%) of 14 with any baseline CMBs. Multiple logistic regression analysis indicated that presence of baseline CMBs (risk ratio [RR] 5.95, 95% CI 2.69–13.20, p < 0.001) and lower platelets level (risk ratio [RR] 0.992, 95% CI 0.986–0.998, p = 0.007) were independently associated with new CMBs. The baseline load of CMBs was not associated with the risk of hemorrhagic transformation. Conclusion In this study, new CMBs were found in nearly 30% of patients with AIS on the 7–9 days after rtPA treatment. Baseline CMBs correlated with a higher risk of new CMBs appearing after the rtPA treatment, independently of other factors. At the same time, in our sample, baseline CMBs did not correlate with an increased risk of hemorrhagic transformation. Since the associations between the CMBs load and cognitive impairment have already been proved, further studies are warranted to investigate possible associations between the thrombolytic treatment of patients with AIS, mainly those with baseline CMBs, and the risk of earlier cognitive decline.
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Affiliation(s)
- Bartosz Jabłoński
- Department of Adult Neurology, University Clinical Center, Medical University of Gdańsk, Gdańsk, Poland
| | - Anna Gójska-Grymajło
- Department of Adult Neurology, University Clinical Center, Medical University of Gdańsk, Gdańsk, Poland
| | - Daria Ossowska
- Department of Adult Neurology, University Clinical Center, Medical University of Gdańsk, Gdańsk, Poland.,II Department of Radiology, Medical University of Gdańsk, Department of Radiology, University Clinical Centre, Gdańsk, Poland
| | - Edyta Szurowska
- II Department of Radiology, Medical University of Gdańsk, Department of Radiology, University Clinical Centre, Gdańsk, Poland
| | - Adam Wyszomirski
- Department of Adult Neurology, University Clinical Center, Medical University of Gdańsk, Gdańsk, Poland
| | - Bartłomiej Rojek
- Department of Adult Neurology, University Clinical Center, Medical University of Gdańsk, Gdańsk, Poland
| | - Bartosz Karaszewski
- Department of Adult Neurology, University Clinical Center, Medical University of Gdańsk, Gdańsk, Poland
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9
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SWATH-MS for prospective identification of protein blood biomarkers of rtPA-associated intracranial hemorrhage in acute ischemic stroke: a pilot study. Sci Rep 2021; 11:18765. [PMID: 34548538 PMCID: PMC8455557 DOI: 10.1038/s41598-021-97710-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 08/27/2021] [Indexed: 11/08/2022] Open
Abstract
Intravenous recombinant tissue plasminogen activator (rtPA) is, besides mechanical thrombectomy, the highest class evidence based reperfusion treatment of acute ischemic stroke (AIS). The biggest concern of the therapy is symptomatic intracranial hemorrhage (sICH), which occurs in 3-7% of all treated patients, and is associated with worse functional outcome. Finding a method of the powerful identification of patients at highest risk of sICH, in order to increase the percentage of stroke patients safely treated with rtPA, is one of the most important challenges in stroke research. To address this problem, we designed a complex project to identify blood, neuroimaging, and clinical biomarkers combined for prospective assessment of the risk of rtPA-associated ICH. In this paper we present results of blood proteomic and peptide analysis of pilot 41 AIS patients before rtPA administration (the test ICH group, n = 9 or the controls, without ICH, n = 32). We demonstrated that pre-treatment blood profiles of 15 proteins differ depending on whether the patients develop rtPA-associated ICH or not. SWATH-MS quantification of serum or plasma proteins might allow for robust selection of blood biomarkers to increase the prospective assessment of rtPA-associated ICH over that based solely on clinical and neuroimaging characteristics.
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10
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Adverse consequences of immediate thrombolysis-related complications: a multi-centre registry-based cohort study of acute stroke. J Thromb Thrombolysis 2021; 53:218-227. [PMID: 34255266 PMCID: PMC8791861 DOI: 10.1007/s11239-021-02523-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2021] [Indexed: 10/27/2022]
Abstract
Complications following thrombolysis for stroke are well documented, and mostly concentrated on haemorrhage. However, the consequences of patients who experience any immediate thrombolysis-related complications (TRC) compared to patients without immediate TRC have not been examined. Prospectively collected data from the Sentinel Stroke National Audit Programme were analysed. Thrombolysis was performed in 451 patients (52.1% men; 75.3 years ± 13.2) admitted with acute ischaemic stroke (AIS) in four UK centres between 2014 and 2016. Adverse consequences following immediate TRC were assessed using logistic regression, adjusted for age, sex and co-morbidities. Twenty-nine patients (6.4%) acquired immediate TRC. Compared to patients without, individuals with immediate TRC had greater adjusted risks of: moderately-severe or severe stroke (National Institutes of Health for Stroke Scale score ≥ 16) at 24-h (5.7% vs 24.7%, OR 3.9, 95% CI 1.4-11.1); worst level of consciousness (LOC) in the first 7 days (score ≥ 1; 25.0 vs 60.7, OR 4.6, 95% CI 2.1-10.2); urinary tract infection or pneumonia within 7-days of admission (13.5% vs 39.3%, OR 3.2, 95% CI 1.3-7.7); length of stay (LOS) on hyperacute stroke unit (HASU) ≥ 2 weeks (34.7% vs 66.7%, OR 5.2, 95% CI 1.5-18.4); mortality (13.0% vs 41.4%, OR 3.7, 95% CI 1.6-8.4); moderately-severe or severe disability (modified Rankin Scale score ≥ 4) at discharge (26.8% vs 65.5%, OR 4.7, 95% CI 2.1-10.9); palliative care by discharge date (5.1% vs 24.1%, OR 5.1, 95% CI 1.7-15.7). The median LOS on the HASU was longer (7 days vs 30 days, Kruskal-Wallis test: χ2 = 8.9, p = 0.003) while stroke severity did not improve (NIHSS score at 24-h post-thrombolysis minus NIHSS score at arrival = - 4 vs 0, χ2 = 24.3, p < 0.001). In conclusion, the risk of nosocomial infections, worsening of stroke severity, longer HASU stay, disability and death is increased following immediate TRC. The management of patients following immediate TRC is more complex than previously thought and such complexity needs to be considered when planning an increased thrombolysis service.
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11
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Chen J, Duris K, Yang X. Effect of cerebral microbleeds on hemorrhagic transformation and functional prognosis after intravenous thrombolysis of cerebral infarction. BRAIN HEMORRHAGES 2021. [DOI: 10.1016/j.hest.2021.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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12
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Yang T, Jing H, Cao Y, Lin X, Yan J, Xiao M, Huang X, Cheng Z, Han Z. The Relationship of the Type of Intracerebral Hemorrhage to Early Disease Evolution and Long-Term Prognosis After r-tPA Thrombolysis. Clin Appl Thromb Hemost 2021; 27:1076029621992125. [PMID: 33872083 PMCID: PMC8058783 DOI: 10.1177/1076029621992125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
To investigate the relationship of different subtypes of intracerebral hemorrhage (ICH) to early disease evolution and long-term prognosis in patients with acute cerebral infarction after intravenous recombinant tissue plasminogen activator(r-tPA). Seventy ischemic stroke patients treated with intravenous r-tPA who underwent computed tomography (CT) within 24 hours after thrombolysis were divided into 4 types (hemorrhagic infarction type 1 [HI-1], HI-2, parenchymal hemorrhage type 1 [PH-1], or PH-2 which according to the size of the hematoma and the presence or absence of space-occupying effect). Early evolution of the disease was observed by the change in the National Institutes of Health Stroke Scale (NIHSS) score within 24 hours after thrombolysis. The long-term prognosis was assessed by the modified Rankin Scale (mRS) score at the third month. There were 17 (24.3%) patients with ICH. Compared with patients in the non-ICH group, HI did not affect early neurological function or clinical outcome at the third month. PH-1 did not increase the risk of early neurological deterioration; however, PH-1 has a tendency to increase the risk of death at the third month (50% vs 11.3%, P = 0.090). PH-2 was significantly related to early neurological deterioration (66.7% vs 3.8%, P < 0.001) and mortality at the third month (50.0% vs 11.3%, P = 0.040). Patients with different subtypes of ICH after thrombolysis have different clinical outcomes. PH-2 is significantly associated with early neurological deterioration and increases mortality at the third month.
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Affiliation(s)
- Ting Yang
- Department of Emergency, 26453The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Hongfei Jing
- Department of Neurology, 274836Zhuozhou City Hospital, Zhuozhou, Hebei, China.,Department of Neurology, 89657The First Affiliate Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yungang Cao
- Department of Neurology, 26453The Second Affiliate Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xianda Lin
- Department of Neurology, Wenzhou Peoples' Hospital, Wenzhou, Zhejiang, China
| | - Jueyue Yan
- First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Meijuan Xiao
- Department of Neurology, 89657The First Affiliate Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaoyan Huang
- Department of Neurology, 26453The Second Affiliate Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zicheng Cheng
- Department of Neurology, 26453The Second Affiliate Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhao Han
- Department of Neurology, 26453The Second Affiliate Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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13
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Gutierrez SAS, Co COC, Trias EC, Pineda-Franks MCC. Symptomatic Intracerebral Hemorrhage After Intravenous Thrombolysis Administration in an Acute Ischemic Stroke Patient with Chronic Pontine Microbleeds, a Case Report. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.100964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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14
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Turner N, Pickering D, Jones K. Physiotherapists' experiences of early mobilization after stroke thrombolysis in England and Wales: A qualitative study. Physiother Theory Pract 2020; 38:774-781. [PMID: 32735467 DOI: 10.1080/09593985.2020.1799462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Thrombolysis with tissue plasminogen activator is a mainstream treatment for ischemic stroke. Known risks with thrombolysis include intracerebral hemorrhage and bleeding elsewhere in the body. There are no specific recommendations for the timing of commencing mobility rehabilitation after thrombolysis. Research evidence for early mobilization (within 24 hours) after thrombolysis is sparse and little is known about physiotherapy practice in the UK. Purpose: This exploratory study aimed to investigate the experiences, including clinical decision-making of physiotherapists in England and Wales regarding early mobilization after thrombolysis. METHODS A qualitative study with interpretative paradigm using a phenomenological methodology. Semi-structured interviews were conducted with a purposive sample. Thematic analysis triangulated by participant and researcher review of resultant themes was supported by NVivo software. A reflexive diary was maintained throughout. RESULTS Data saturation was reached after 14 interviews. All participants reported experience of early mobilization after thrombolysis, with no reported harm or serious incident. Themes included descriptions of practice, perceived benefits and harms, and implementation of risk assessment and management strategies. CONCLUSIONS Physiotherapists describe a variety of practices with careful implementation of any early mobilization after thrombolysis. Common factors of risk assessment reported by participants could contribute to guideline development.
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Affiliation(s)
- Nicola Turner
- Physiotherapy Department, University Hospital of Wales, Cardiff, UK
| | - Dawn Pickering
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Karen Jones
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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15
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Lin X, Cao Y, Yan J, Zhang Z, Ye Z, Huang X, Cheng Z, Han Z. Risk Factors for Early Intracerebral Hemorrhage after Intravenous Thrombolysis with Alteplase. J Atheroscler Thromb 2020; 27:1176-1182. [PMID: 32115471 PMCID: PMC7803839 DOI: 10.5551/jat.49783] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Aim: Intracerebral hemorrhage (ICH) is one of the most severe complications of thrombolysis. Symptomatic ICHs are associated with adverse outcomes. It has been reported that symptomatic ICHs most commonly occur within the first few hours after the initiation of intravenous thrombolysis. Our aim here was to determine the risk factors for early ICH (within 12 h) after thrombolysis. Methods: We analyzed patients with acute ischemic stroke who received intravenous alteplase at two hospitals affiliated to Wenzhou Medical University between March 2008 and November 2017. The ICH diagnosis time was defined as the time from the intravenous administration of alteplase to the first detection of hemorrhage on computed tomography. Demographic data, medical history, clinical features, and laboratory examination results were collected. Univariate analysis followed by multivariable logistic regression analysis was performed to determine the predictors of early ICH (within 12 h) after thrombolysis. Results: Among 197 patients, early ICH (within 12 h) after thrombolysis occurred in 13 patients (6.6%). In the univariate analysis, patients with early ICHs were significantly correlated with prior stroke (P = 0.04). After adjusting for potential confounders in the multivariate analysis, prior stroke (odds ratio [OR]: 5.752, 95% confidence interval [CI]: 1.487–22.248; P = 0.011) and atrial fibrillation (OR: 5.428, 95% CI: 1.427–20.640; P = 0.013) were associated with early ICH. Conclusions: Prior stroke and atrial fibrillation are independent risk factors for early ICHs (within 12 h) after intravenous thrombolysis with alteplase.
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Affiliation(s)
- Xianda Lin
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University.,Department of Neurology, The Wenzhou Third Clinical Institute Affiliated To Wenzhou Medical University
| | - Yungang Cao
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
| | - Jueyue Yan
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
| | - Zheng Zhang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University
| | - Zusen Ye
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University
| | - Xiaoyan Huang
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
| | - Zicheng Cheng
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
| | - Zhao Han
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
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16
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Modrego PJ. The Risk of Symptomatic Intracranial Hemorrhage after Thrombolysis for Acute Stroke: Current Concepts and Perspectives. Ann Indian Acad Neurol 2019; 22:336-340. [PMID: 31359953 PMCID: PMC6613400 DOI: 10.4103/aian.aian_323_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Thrombolysis is the standard of treatment for acute ischemic stroke, with a time window of up to 4½ h from stroke onset. Despite the long experience with the use of recombinant tissue plasminogen activator and the adherence to protocols symptomatic intracranial hemorrhage (SICH) may occur in around 6% of cases, with high-mortality rate and poor-functional outcomes. Many patients are excluded from thrombolysis on the basis of an evaluation of known risk factors, but there are other less known factors involved. Objective The purpose of this work is to analyze the less known risk factors for SICH after thrombolysis. A search of articles related with this field has been undertaken in PubMed with the keywords (brain hemorrhage, thrombolysis, and acute ischemic stroke). Some risk factors for SICH have emerged such as previous microbleeds on brain magnetic resonance imaging, leukoaraiosis, and previous antiplatelet drug use or statin use. Serum matrix metalloproteinases have emerged as a promising biomarker for better selection of patients, but further research is needed. Conclusions In addition to the already known risk factors considered in the standard protocols, an individualized evaluation of risks is needed to minimize the risk of brain hemorrhage after thrombolysis for ischemic stroke.
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Affiliation(s)
- Pedro J Modrego
- Department of Neurology, Hospital Universitario Miguel Servet, Zaragoza, Spain
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17
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Huang Q, Lan T, Lu J, Zhang H, Zhang D, Lou T, Xu P, Ren J, Zhao D, Sun L, Li X, Wang J. DiDang Tang Inhibits Endoplasmic Reticulum Stress-Mediated Apoptosis Induced by Oxygen Glucose Deprivation and Intracerebral Hemorrhage Through Blockade of the GRP78-IRE1/PERK Pathways. Front Pharmacol 2018; 9:1423. [PMID: 30564125 PMCID: PMC6288198 DOI: 10.3389/fphar.2018.01423] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 11/19/2018] [Indexed: 12/14/2022] Open
Abstract
DiDang Tang (DDT), a Chinese traditional medicine formula, contains 4 Chinese traditional medicine substances, has been widely used to treat intracerebral hemorrhage (ICH) patients. However, the molecular mechanisms of DDT for protecting neurons from oxygen and glucose deprivation (OGD)-induced endoplasmic reticulum (ER) stress and apoptosis after ICH still remains elusive. In this study, high-performance liquid chromatography fingerprint analysis was performed to learn the features of the chemical compositions of DDT. OGD-induced ER stress, Ca2+ overload, and mitochondrial apoptosis were investigated in nerve growth factor -induced PC12, primary neuronal cells, and ICH rats to evaluate the protective effect of DDT. We found that DDT treatment protected neurons against OGD-induced damage and apoptosis by increasing cell viability and reducing the release of lactate dehydrogenase. DDT decreased OGD-induced Ca2+ overload and ER stress through the blockade of the glucose-regulated protein 78 (GRP78)- inositol-requiring protein 1α (IRE1)/ protein kinase RNA-like ER kinase (PERK) pathways and also inhibited apoptosis by decreasing mitochondrial damage. Moreover, we observed similar findings when we studied DDT for inhibition of ER stress in a rat model of ICH. In addition, our experiments further confirmed the neuroprotective potential of DDT against tunicamycin (TM)-induced neural damage. Our in vitro and in vivo results indicated that the neuroprotective effect of DDT against ER stress damage and apoptosis occurred mainly by blocking the GPR78-IRE1/PERK pathways. Taken together, it provides reliable experimental evidence and explains the molecular mechanism of DDT for the treatment of patients with ICH.
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Affiliation(s)
- Qingxia Huang
- Research Center of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China.,Jilin Provincial Key Laboratory of BioMacromolecules of Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Tianye Lan
- Department of Encephalopathy, Changchun University of Chinese Medicine, Changchun, China
| | - Jing Lu
- Research Center of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China.,Jilin Provincial Key Laboratory of BioMacromolecules of Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - He Zhang
- Research Center of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China.,Jilin Provincial Key Laboratory of BioMacromolecules of Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Dongmei Zhang
- Scientific Research Office, Changchun University of Chinese Medicine, Changchun, China
| | - Tingting Lou
- Research Center of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China.,Jilin Provincial Key Laboratory of BioMacromolecules of Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Peng Xu
- Department of Encephalopathy, Changchun University of Chinese Medicine, Changchun, China
| | - Jixiang Ren
- Department of Encephalopathy, Changchun University of Chinese Medicine, Changchun, China
| | - Daqing Zhao
- Jilin Provincial Key Laboratory of BioMacromolecules of Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China.,Jilin Ginseng Academy, Changchun University of Chinese Medicine, Changchun, China
| | - Liwei Sun
- Research Center of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Xiangyan Li
- Jilin Provincial Key Laboratory of BioMacromolecules of Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China.,Jilin Ginseng Academy, Changchun University of Chinese Medicine, Changchun, China
| | - Jian Wang
- Department of Encephalopathy, Changchun University of Chinese Medicine, Changchun, China
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18
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Fladt J, Kronlage C, De Marchis GM. Cerebral White Matter Hyperintensities and Microbleeds in Acute Ischemic Stroke: Impact on Recanalization Therapies. A Review of the Literature. Neurosci Lett 2018; 687:55-64. [PMID: 30194982 DOI: 10.1016/j.neulet.2018.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/31/2018] [Accepted: 09/03/2018] [Indexed: 12/30/2022]
Abstract
Cerebral white matter hyperintensities (WMH) and cerebral microbleeds (CMBs) are frequently seen on brain imaging acquired for acute ischemic stroke. Given the raising use of recanalization therapies - both intravenous and endovascular - the interest on the impact of WMH and CMBs on the risk of intracerebral hemorrhage and on functional outcome is growing. In this review, we will discuss the relevance of WMH and CMBs among patients with an acute ischemic stroke, focusing on the implications for recanalization therapies.
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Affiliation(s)
- J Fladt
- Department of Neurology, University Hospital Basel, Switzerland
| | - C Kronlage
- Department of Neurology, University Hospital Basel, Switzerland
| | - G M De Marchis
- Department of Neurology, University Hospital Basel, Switzerland.
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19
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20
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Erdur H, Polymeris A, Grittner U, Scheitz JF, Tütüncü S, Seiffge DJ, Audebert HJ, Nolte CH, Engelter ST, Rocco A. A Score for Risk of Thrombolysis-Associated Hemorrhage Including Pretreatment with Statins. Front Neurol 2018; 9:74. [PMID: 29503629 PMCID: PMC5820302 DOI: 10.3389/fneur.2018.00074] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 02/01/2018] [Indexed: 01/09/2023] Open
Abstract
Background Symptomatic intracranial hemorrhage (sICH) after intravenous thrombolysis with recombinant tissue-plasminogen activator (rt-PA) for acute ischemic stroke is associated with a poor functional outcome. We aimed to develop a score assessing risk of sICH including novel putative predictors-namely, pretreatment with statins and severe renal impairment. Methods We analyzed our local cohort (Berlin) of patients receiving rt-PA for acute ischemic stroke between 2006 and 2016. Outcome was sICH according to ECASS-III criteria. A multiple regression model identified variables associated with sICH and receiver operating characteristics were calculated for the best discriminatory model for sICH. The model was validated in an independent thrombolysis cohort (Basel). Results sICH occurred in 53 (4.0%) of 1,336 patients in the derivation cohort. Age, baseline National Institutes of Health Stroke Scale, systolic blood pressure on admission, blood glucose on admission, and prior medication with medium- or high-dose statins were associated with sICH and included into the risk of intracranial hemorrhage score. The validation cohort included 983 patients of whom 33 (3.4%) had a sICH. c-Statistics for sICH was 0.72 (95% CI 0.66-0.79) in the derivation cohort and 0.69 (95% CI 0.60-0.77) in the independent validation cohort. Inclusion of severe renal impairment did not improve the score. Conclusion We developed a simple score with fair discriminating capability to predict rt-PA-related sICH by adding prior statin use to known prognostic factors of sICH. This score may help clinicians to identify patients with higher risk of sICH requiring intensive monitoring.
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Affiliation(s)
- Hebun Erdur
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Alexandros Polymeris
- Department of Neurology and Stroke Center, University of Basel, University Hospital Basel, Basel, Switzerland
| | - Ulrike Grittner
- Center for Stroke Research, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department for Biostatistics and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jan F Scheitz
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research, Charité-Universitätsmedizin Berlin, Berlin, Germany.,NeuroCure, Cluster of Excellence, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Serdar Tütüncü
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - David J Seiffge
- Department of Neurology and Stroke Center, University of Basel, University Hospital Basel, Basel, Switzerland
| | - Heinrich J Audebert
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christian H Nolte
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan T Engelter
- Department of Neurology and Stroke Center, University of Basel, University Hospital Basel, Basel, Switzerland.,Neurorehabilitation Unit, University of Basel, University Center for Medicine of Aging and Rehabilitation, Felix Platter Hospital, Basel, Switzerland
| | - Andrea Rocco
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
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21
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Tóth NK, Székely EG, Czuriga-Kovács KR, Sarkady F, Nagy O, Lánczi LI, Berényi E, Fekete K, Fekete I, Csiba L, Bagoly Z. Elevated Factor VIII and von Willebrand Factor Levels Predict Unfavorable Outcome in Stroke Patients Treated with Intravenous Thrombolysis. Front Neurol 2018; 8:721. [PMID: 29410644 PMCID: PMC5787073 DOI: 10.3389/fneur.2017.00721] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 12/13/2017] [Indexed: 11/13/2022] Open
Abstract
Introduction Plasma factor VIII (FVIII) and von Willebrand factor (VWF) levels have been associated with the rate and severity of arterial thrombus formation and have been linked to outcomes following thrombolytic therapy in acute myocardial infarction patients. Here, we aimed to investigate FVIII and VWF levels during the course of thrombolysis in acute ischemic stroke (AIS) patients and to find out whether they predict long-term outcomes. Materials and methods Study population included 131 consecutive AIS patients (median age: 69 years, 60.3% men) who underwent i.v. thrombolysis with recombinant tissue plasminogen activator (rt-PA). Blood samples were taken on admission, 1 and 24 h after rt-PA administration to measure FVIII activity and VWF antigen levels. Neurological deficit of patients was determined according to the National Institutes of Health Stroke Scale (NIHSS). ASPECT scores were assessed using computer tomography images taken before and 24 h after thrombolysis. Intracranial hemorrhage was classified according to the European Cooperative Acute Stroke Study (ECASS) II criteria. Long-term functional outcome was determined at 90 days after the event by the modified Rankin scale (mRS). Results VWF levels on admission were significantly elevated in case of more severe AIS [median and IQR values: NIHSS <6:189.6% (151.9-233.2%); NIHSS 6-16: 199.6% (176.4-250.8%); NIHSS >16: 247.8% (199.9-353.8%), p = 0.013]; similar, but non-significant trend was observed for FVIII levels. FVIII and VWF levels correlated well on admission (r = 0.748, p < 0.001) but no significant correlation was found immediately after thrombolysis (r = 0.093, p = 0.299), most probably due to plasmin-mediated FVIII degradation. VWF levels at all investigated occasions and FVIII activity before and 24 h after thrombolysis were associated with worse 24 h post-lysis ASPECT scores. In a binary backward logistic regression analysis including age, gender, high-sensitivity C-reactive protein, active smoking, diabetes, and NIHSS >5 on admission, elevated FVIII and VWF levels after thrombolysis were independently associated with poor functional outcomes (mRS ≥ 3) at 90 days (immediately after thrombolysis: FVIII: OR: 7.10, 95% CI: 1.77-28.38, p = 0.006, VWF: OR: 6.31, 95% CI: 1.83-21.73, p = 0.003; 24 h after thrombolysis: FVIII: OR: 4.67, 95% CI: 1.42-15.38, p = 0.011, VWF: OR: 19.02, 95% CI: 1.94-186.99, p = 0.012). Conclusion Elevated FVIII activity and VWF antigen levels immediately after lysis and at 24 h post-therapy were shown to have independent prognostic values regarding poor functional outcomes at 90 days.
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Affiliation(s)
- Noémi Klára Tóth
- Division of Clinical Laboratory Sciences, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Edina Gabriella Székely
- Division of Clinical Laboratory Sciences, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | | | - Ferenc Sarkady
- Division of Clinical Laboratory Sciences, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Orsolya Nagy
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Levente István Lánczi
- Department of Radiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ervin Berényi
- Department of Radiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Klára Fekete
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - István Fekete
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - László Csiba
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,MTA-DE Cerebrovascular and Neurodegenerative Research Group, Debrecen, Hungary
| | - Zsuzsa Bagoly
- Division of Clinical Laboratory Sciences, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,MTA-DE Cerebrovascular and Neurodegenerative Research Group, Debrecen, Hungary
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22
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Karaszewski B. Complex relations between body temperature, tPA action, and stroke outcome. Acta Neurol Scand 2018; 137:149-150. [PMID: 29205272 DOI: 10.1111/ane.12858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- B. Karaszewski
- Department of Adult Neurology; Medical University of Gdansk & University Clinical Center in Gdansk; Gdańsk Poland
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23
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Chen Y, Yan S, Xu M, Zhong G, Liebeskind DS, Lou M. More extensive white matter hyperintensity is linked with higher risk of remote intracerebral hemorrhage after intravenous thrombolysis. Eur J Neurol 2017; 25:380-e15. [PMID: 29115734 DOI: 10.1111/ene.13517] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 11/02/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Y. Chen
- Department of Neurology The Second Affiliated Hospital of Zhejiang University School of Medicine Hangzhou China
| | - S. Yan
- Department of Neurology The Second Affiliated Hospital of Zhejiang University School of Medicine Hangzhou China
| | - M. Xu
- Department of Neurology The Second Affiliated Hospital of Zhejiang University School of Medicine Hangzhou China
| | - G. Zhong
- Department of Neurology The Second Affiliated Hospital of Zhejiang University School of Medicine Hangzhou China
| | | | - M. Lou
- Department of Neurology The Second Affiliated Hospital of Zhejiang University School of Medicine Hangzhou China
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24
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Qiu M, Fang M, Liu X. Low free triiodothyronine levels predict symptomatic intracranial hemorrhage and worse short-term outcome of thrombolysis in patients with acute ischemia stroke. Medicine (Baltimore) 2017; 96:e8539. [PMID: 29137061 PMCID: PMC5690754 DOI: 10.1097/md.0000000000008539] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The aim of the study was to determine whether thyroid hormones level on admission in patients with ischemic stroke, treated with intravenous recombinant tissue type plasminogen activator (rtPA), was associated with symptomatic intracranial hemorrhage (sICH) and worse outcomes at 3 months.Patients with acute ischemic stroke (AIS) receiving intravenous rtPA thrombolytic treatment on our stroke unit between January 2015 and June 2016 were included in this study. Serum-free triiodothyronine (fT3), free thyroxine (fT4), total triiodothyronine (tT3), total thyroxine (tT4), and thyroid-stimulating hormone (TSH) were detected on admission. The endpoints were sICH, and poor functional outcomes at 3 and 6 months.In all, 159 patients (106 males; mean age 65.36 ± 10.02 years) were included. FT3 was independently associated with sICH (odds ratio [OR] 0.204, 95% confidence interval [CI] 0.065-0.642) and poor outcomes at 3 months (OR 0.396, 95% CI 0.180-1.764). The cut-off values of fT3 for sICH was 3.54 pg/mL (sensitivity 83%; specificity 83%; area under the curve 0.88). FT3 values ≤3.54 pg/mL increased risk for sICH by 3.16-fold (95% CI 0.75-1.0) compared with fT3 values >3.54 pg/mL.Low fT3 levels at admission were independently associated with sICH and worse outcomes at 3 months in AIS patients receiving rtPA thrombolytic therapy.
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25
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Wyszomirski A, Szczyrba S, Tomaka D, Karaszewski B. Treatment of acute basilar artery occlusion: Systematic review and meta-analysis. Neurol Neurochir Pol 2017; 51:486-496. [DOI: 10.1016/j.pjnns.2017.07.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 07/13/2017] [Accepted: 07/17/2017] [Indexed: 10/19/2022]
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26
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Werring DJ, Charidimou A. Response by Werring and Charidimou to Letter Regarding Article, "Microbleeds, Cerebral Hemorrhage, and Functional Outcome After Stroke Thrombolysis: Individual Patient Data Meta-Analysis". Stroke 2017; 48:e332. [PMID: 29030477 DOI: 10.1161/strokeaha.117.019038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- David J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, United Kingdom
| | - Andreas Charidimou
- Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston
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27
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Charidimou A, Turc G, Oppenheim C, Yan S, Scheitz JF, Erdur H, Klinger-Gratz PP, El-Koussy M, Takahashi W, Moriya Y, Wilson D, Kidwell CS, Saver JL, Sallem A, Moulin S, Edjlali-Goujon M, Thijs V, Fox Z, Shoamanesh A, Albers GW, Mattle HP, Benavente OR, Jäger HR, Ambler G, Aoki J, Baron JC, Kimura K, Kakuda W, Takizawa S, Jung S, Nolte CH, Lou M, Cordonnier C, Werring DJ. Microbleeds, Cerebral Hemorrhage, and Functional Outcome After Stroke Thrombolysis. Stroke 2017; 48:2084-2090. [DOI: 10.1161/strokeaha.116.012992] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background and Purpose—
We assessed whether the presence, number, and distribution of cerebral microbleeds (CMBs) on pre-intravenous thrombolysis MRI scans of acute ischemic stroke patients are associated with an increased risk of intracerebral hemorrhage (ICH) or poor functional outcome.
Methods—
We performed an individual patient data meta-analysis, including prospective and retrospective studies of acute ischemic stroke treated with intravenous tissue-type plasminogen activator. Using multilevel mixed-effects logistic regression, we investigated associations of pre-treatment CMB presence, burden (1, 2–4, ≥5, and >10), and presumed pathogenesis (cerebral amyloid angiopathy defined as strictly lobar CMBs and noncerebral amyloid angiopathy) with symptomatic ICH, parenchymal hematoma (within [parenchymal hemorrhage, PH] and remote from the ischemic area [remote parenchymal hemorrhage, PHr]), and poor 3- to 6-month functional outcome (modified Rankin score >2).
Results—
In 1973 patients from 8 centers, the crude prevalence of CMBs was 526 of 1973 (26.7%). A total of 77 of 1973 (3.9%) patients experienced symptomatic ICH, 210 of 1806 (11.6%) experienced PH, and 56 of 1720 (3.3%) experienced PHr. In adjusted analyses, patients with CMBs (compared with those without CMBs) had increased risk of PH (odds ratio: 1.50; 95% confidence interval: 1.09–2.07;
P
=0.013) and PHr (odds ratio: 3.04; 95% confidence interval: 1.73–5.35;
P
<0.001) but not symptomatic ICH. Both cerebral amyloid angiopathy and noncerebral amyloid angiopathy patterns of CMBs were associated with PH and PHr. Increasing CMB burden category was associated with the risk of symptomatic ICH (
P
=0.014), PH (
P
=0.013), and PHr (
P
<0.00001). Five or more and >10 CMBs independently predicted poor 3- to 6-month outcome (odds ratio: 1.85; 95% confidence interval: 1.10–3.12;
P
=0.020; and odds ratio: 3.99; 95% confidence interval: 1.55–10.22;
P
=0.004, respectively).
Conclusions—
Increasing CMB burden is associated with increased risk of ICH (including PHr) and poor 3- to 6-month functional outcome after intravenous thrombolysis for acute ischemic stroke.
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Affiliation(s)
- Andreas Charidimou
- From the Stroke Research Centre, UCL Institute of Neurology, London, United Kingdom (A.C., D.W., D.J.W.); Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston (A.C.); Departments of Neurology and Radiology, Hôpital Sainte-Anne, Université Paris Descartes, France (G.T., C.O., M.E.-G., J.-C.B.); Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (S.Y., M.L.); Department of Neurology and Center for Stroke Research,
| | - Guillaume Turc
- From the Stroke Research Centre, UCL Institute of Neurology, London, United Kingdom (A.C., D.W., D.J.W.); Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston (A.C.); Departments of Neurology and Radiology, Hôpital Sainte-Anne, Université Paris Descartes, France (G.T., C.O., M.E.-G., J.-C.B.); Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (S.Y., M.L.); Department of Neurology and Center for Stroke Research,
| | - Catherine Oppenheim
- From the Stroke Research Centre, UCL Institute of Neurology, London, United Kingdom (A.C., D.W., D.J.W.); Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston (A.C.); Departments of Neurology and Radiology, Hôpital Sainte-Anne, Université Paris Descartes, France (G.T., C.O., M.E.-G., J.-C.B.); Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (S.Y., M.L.); Department of Neurology and Center for Stroke Research,
| | - Shenqiang Yan
- From the Stroke Research Centre, UCL Institute of Neurology, London, United Kingdom (A.C., D.W., D.J.W.); Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston (A.C.); Departments of Neurology and Radiology, Hôpital Sainte-Anne, Université Paris Descartes, France (G.T., C.O., M.E.-G., J.-C.B.); Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (S.Y., M.L.); Department of Neurology and Center for Stroke Research,
| | - Jan F. Scheitz
- From the Stroke Research Centre, UCL Institute of Neurology, London, United Kingdom (A.C., D.W., D.J.W.); Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston (A.C.); Departments of Neurology and Radiology, Hôpital Sainte-Anne, Université Paris Descartes, France (G.T., C.O., M.E.-G., J.-C.B.); Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (S.Y., M.L.); Department of Neurology and Center for Stroke Research,
| | - Hebun Erdur
- From the Stroke Research Centre, UCL Institute of Neurology, London, United Kingdom (A.C., D.W., D.J.W.); Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston (A.C.); Departments of Neurology and Radiology, Hôpital Sainte-Anne, Université Paris Descartes, France (G.T., C.O., M.E.-G., J.-C.B.); Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (S.Y., M.L.); Department of Neurology and Center for Stroke Research,
| | - Pascal P. Klinger-Gratz
- From the Stroke Research Centre, UCL Institute of Neurology, London, United Kingdom (A.C., D.W., D.J.W.); Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston (A.C.); Departments of Neurology and Radiology, Hôpital Sainte-Anne, Université Paris Descartes, France (G.T., C.O., M.E.-G., J.-C.B.); Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (S.Y., M.L.); Department of Neurology and Center for Stroke Research,
| | - Marwan El-Koussy
- From the Stroke Research Centre, UCL Institute of Neurology, London, United Kingdom (A.C., D.W., D.J.W.); Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston (A.C.); Departments of Neurology and Radiology, Hôpital Sainte-Anne, Université Paris Descartes, France (G.T., C.O., M.E.-G., J.-C.B.); Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (S.Y., M.L.); Department of Neurology and Center for Stroke Research,
| | - Wakoh Takahashi
- From the Stroke Research Centre, UCL Institute of Neurology, London, United Kingdom (A.C., D.W., D.J.W.); Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston (A.C.); Departments of Neurology and Radiology, Hôpital Sainte-Anne, Université Paris Descartes, France (G.T., C.O., M.E.-G., J.-C.B.); Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (S.Y., M.L.); Department of Neurology and Center for Stroke Research,
| | - Yusuke Moriya
- From the Stroke Research Centre, UCL Institute of Neurology, London, United Kingdom (A.C., D.W., D.J.W.); Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston (A.C.); Departments of Neurology and Radiology, Hôpital Sainte-Anne, Université Paris Descartes, France (G.T., C.O., M.E.-G., J.-C.B.); Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (S.Y., M.L.); Department of Neurology and Center for Stroke Research,
| | - Duncan Wilson
- From the Stroke Research Centre, UCL Institute of Neurology, London, United Kingdom (A.C., D.W., D.J.W.); Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston (A.C.); Departments of Neurology and Radiology, Hôpital Sainte-Anne, Université Paris Descartes, France (G.T., C.O., M.E.-G., J.-C.B.); Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (S.Y., M.L.); Department of Neurology and Center for Stroke Research,
| | - Chelsea S. Kidwell
- From the Stroke Research Centre, UCL Institute of Neurology, London, United Kingdom (A.C., D.W., D.J.W.); Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston (A.C.); Departments of Neurology and Radiology, Hôpital Sainte-Anne, Université Paris Descartes, France (G.T., C.O., M.E.-G., J.-C.B.); Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (S.Y., M.L.); Department of Neurology and Center for Stroke Research,
| | - Jeffrey L. Saver
- From the Stroke Research Centre, UCL Institute of Neurology, London, United Kingdom (A.C., D.W., D.J.W.); Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston (A.C.); Departments of Neurology and Radiology, Hôpital Sainte-Anne, Université Paris Descartes, France (G.T., C.O., M.E.-G., J.-C.B.); Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (S.Y., M.L.); Department of Neurology and Center for Stroke Research,
| | - Asma Sallem
- From the Stroke Research Centre, UCL Institute of Neurology, London, United Kingdom (A.C., D.W., D.J.W.); Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston (A.C.); Departments of Neurology and Radiology, Hôpital Sainte-Anne, Université Paris Descartes, France (G.T., C.O., M.E.-G., J.-C.B.); Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (S.Y., M.L.); Department of Neurology and Center for Stroke Research,
| | - Solene Moulin
- From the Stroke Research Centre, UCL Institute of Neurology, London, United Kingdom (A.C., D.W., D.J.W.); Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston (A.C.); Departments of Neurology and Radiology, Hôpital Sainte-Anne, Université Paris Descartes, France (G.T., C.O., M.E.-G., J.-C.B.); Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (S.Y., M.L.); Department of Neurology and Center for Stroke Research,
| | - Myriam Edjlali-Goujon
- From the Stroke Research Centre, UCL Institute of Neurology, London, United Kingdom (A.C., D.W., D.J.W.); Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston (A.C.); Departments of Neurology and Radiology, Hôpital Sainte-Anne, Université Paris Descartes, France (G.T., C.O., M.E.-G., J.-C.B.); Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (S.Y., M.L.); Department of Neurology and Center for Stroke Research,
| | - Vincent Thijs
- From the Stroke Research Centre, UCL Institute of Neurology, London, United Kingdom (A.C., D.W., D.J.W.); Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston (A.C.); Departments of Neurology and Radiology, Hôpital Sainte-Anne, Université Paris Descartes, France (G.T., C.O., M.E.-G., J.-C.B.); Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (S.Y., M.L.); Department of Neurology and Center for Stroke Research,
| | - Zoe Fox
- From the Stroke Research Centre, UCL Institute of Neurology, London, United Kingdom (A.C., D.W., D.J.W.); Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston (A.C.); Departments of Neurology and Radiology, Hôpital Sainte-Anne, Université Paris Descartes, France (G.T., C.O., M.E.-G., J.-C.B.); Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (S.Y., M.L.); Department of Neurology and Center for Stroke Research,
| | - Ashkan Shoamanesh
- From the Stroke Research Centre, UCL Institute of Neurology, London, United Kingdom (A.C., D.W., D.J.W.); Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston (A.C.); Departments of Neurology and Radiology, Hôpital Sainte-Anne, Université Paris Descartes, France (G.T., C.O., M.E.-G., J.-C.B.); Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (S.Y., M.L.); Department of Neurology and Center for Stroke Research,
| | - Gregory W. Albers
- From the Stroke Research Centre, UCL Institute of Neurology, London, United Kingdom (A.C., D.W., D.J.W.); Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston (A.C.); Departments of Neurology and Radiology, Hôpital Sainte-Anne, Université Paris Descartes, France (G.T., C.O., M.E.-G., J.-C.B.); Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (S.Y., M.L.); Department of Neurology and Center for Stroke Research,
| | - Heinrich P. Mattle
- From the Stroke Research Centre, UCL Institute of Neurology, London, United Kingdom (A.C., D.W., D.J.W.); Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston (A.C.); Departments of Neurology and Radiology, Hôpital Sainte-Anne, Université Paris Descartes, France (G.T., C.O., M.E.-G., J.-C.B.); Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (S.Y., M.L.); Department of Neurology and Center for Stroke Research,
| | - Oscar R. Benavente
- From the Stroke Research Centre, UCL Institute of Neurology, London, United Kingdom (A.C., D.W., D.J.W.); Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston (A.C.); Departments of Neurology and Radiology, Hôpital Sainte-Anne, Université Paris Descartes, France (G.T., C.O., M.E.-G., J.-C.B.); Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (S.Y., M.L.); Department of Neurology and Center for Stroke Research,
| | - H. Rolf Jäger
- From the Stroke Research Centre, UCL Institute of Neurology, London, United Kingdom (A.C., D.W., D.J.W.); Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston (A.C.); Departments of Neurology and Radiology, Hôpital Sainte-Anne, Université Paris Descartes, France (G.T., C.O., M.E.-G., J.-C.B.); Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (S.Y., M.L.); Department of Neurology and Center for Stroke Research,
| | - Gareth Ambler
- From the Stroke Research Centre, UCL Institute of Neurology, London, United Kingdom (A.C., D.W., D.J.W.); Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston (A.C.); Departments of Neurology and Radiology, Hôpital Sainte-Anne, Université Paris Descartes, France (G.T., C.O., M.E.-G., J.-C.B.); Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (S.Y., M.L.); Department of Neurology and Center for Stroke Research,
| | - Junya Aoki
- From the Stroke Research Centre, UCL Institute of Neurology, London, United Kingdom (A.C., D.W., D.J.W.); Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston (A.C.); Departments of Neurology and Radiology, Hôpital Sainte-Anne, Université Paris Descartes, France (G.T., C.O., M.E.-G., J.-C.B.); Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (S.Y., M.L.); Department of Neurology and Center for Stroke Research,
| | - Jean-Claude Baron
- From the Stroke Research Centre, UCL Institute of Neurology, London, United Kingdom (A.C., D.W., D.J.W.); Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston (A.C.); Departments of Neurology and Radiology, Hôpital Sainte-Anne, Université Paris Descartes, France (G.T., C.O., M.E.-G., J.-C.B.); Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (S.Y., M.L.); Department of Neurology and Center for Stroke Research,
| | - Kazumi Kimura
- From the Stroke Research Centre, UCL Institute of Neurology, London, United Kingdom (A.C., D.W., D.J.W.); Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston (A.C.); Departments of Neurology and Radiology, Hôpital Sainte-Anne, Université Paris Descartes, France (G.T., C.O., M.E.-G., J.-C.B.); Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (S.Y., M.L.); Department of Neurology and Center for Stroke Research,
| | - Wataru Kakuda
- From the Stroke Research Centre, UCL Institute of Neurology, London, United Kingdom (A.C., D.W., D.J.W.); Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston (A.C.); Departments of Neurology and Radiology, Hôpital Sainte-Anne, Université Paris Descartes, France (G.T., C.O., M.E.-G., J.-C.B.); Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (S.Y., M.L.); Department of Neurology and Center for Stroke Research,
| | - Shunya Takizawa
- From the Stroke Research Centre, UCL Institute of Neurology, London, United Kingdom (A.C., D.W., D.J.W.); Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston (A.C.); Departments of Neurology and Radiology, Hôpital Sainte-Anne, Université Paris Descartes, France (G.T., C.O., M.E.-G., J.-C.B.); Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (S.Y., M.L.); Department of Neurology and Center for Stroke Research,
| | - Simon Jung
- From the Stroke Research Centre, UCL Institute of Neurology, London, United Kingdom (A.C., D.W., D.J.W.); Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston (A.C.); Departments of Neurology and Radiology, Hôpital Sainte-Anne, Université Paris Descartes, France (G.T., C.O., M.E.-G., J.-C.B.); Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (S.Y., M.L.); Department of Neurology and Center for Stroke Research,
| | - Christian H. Nolte
- From the Stroke Research Centre, UCL Institute of Neurology, London, United Kingdom (A.C., D.W., D.J.W.); Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston (A.C.); Departments of Neurology and Radiology, Hôpital Sainte-Anne, Université Paris Descartes, France (G.T., C.O., M.E.-G., J.-C.B.); Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (S.Y., M.L.); Department of Neurology and Center for Stroke Research,
| | - Min Lou
- From the Stroke Research Centre, UCL Institute of Neurology, London, United Kingdom (A.C., D.W., D.J.W.); Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston (A.C.); Departments of Neurology and Radiology, Hôpital Sainte-Anne, Université Paris Descartes, France (G.T., C.O., M.E.-G., J.-C.B.); Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (S.Y., M.L.); Department of Neurology and Center for Stroke Research,
| | - Charlotte Cordonnier
- From the Stroke Research Centre, UCL Institute of Neurology, London, United Kingdom (A.C., D.W., D.J.W.); Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston (A.C.); Departments of Neurology and Radiology, Hôpital Sainte-Anne, Université Paris Descartes, France (G.T., C.O., M.E.-G., J.-C.B.); Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (S.Y., M.L.); Department of Neurology and Center for Stroke Research,
| | - David J. Werring
- From the Stroke Research Centre, UCL Institute of Neurology, London, United Kingdom (A.C., D.W., D.J.W.); Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston (A.C.); Departments of Neurology and Radiology, Hôpital Sainte-Anne, Université Paris Descartes, France (G.T., C.O., M.E.-G., J.-C.B.); Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (S.Y., M.L.); Department of Neurology and Center for Stroke Research,
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Zand R, Tsivgoulis G, Singh M, McCormack M, Goyal N, Ishfaq MF, Shahripour RB, Nearing K, Elijovich L, Alexandrov AW, Liebeskind DS, Alexandrov AV. Cerebral Microbleeds and Risk of Intracerebral Hemorrhage Post Intravenous Thrombolysis. J Stroke Cerebrovasc Dis 2017; 26:538-544. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.11.127] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/17/2016] [Accepted: 11/29/2016] [Indexed: 11/27/2022] Open
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Kongbunkiat K, Wilson D, Kasemsap N, Tiamkao S, Jichi F, Palumbo V, Hill MD, Buchan AM, Jung S, Mattle HP, Henninger N, Werring DJ. Leukoaraiosis, intracerebral hemorrhage, and functional outcome after acute stroke thrombolysis. Neurology 2017; 88:638-645. [PMID: 28130468 PMCID: PMC5317383 DOI: 10.1212/wnl.0000000000003605] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 09/27/2016] [Indexed: 11/15/2022] Open
Abstract
Objective: To perform a systematic review and pooled meta-analysis of published studies to assess whether the presence of leukoaraiosis on neuroimaging before treatment with thrombolysis (IV or intra-arterial) is associated with an increased risk of symptomatic intracerebral hemorrhage (sICH) or poor functional outcome. Methods: We included studies of patients with acute ischemic stroke, treated with IV or intra-arterial thrombolysis, which assessed functional outcome (3-month modified Rankin Scale [mRS]) or sICH in relation to leukoaraiosis on pretreatment neuroimaging (CT or MRI). We used random-effects models to calculate pooled relative risks (RR) of sICH and poor functional outcome (mRS ≥ 2) for any vs no leukoaraiosis (using any rating scale) and for no to mild vs moderate to severe leukoaraiosis (using the Van Swieten or Fazekas Schmidt scale). Results: We identified 15 studies (total n = 6,967). For sICH outcome, the RR was 1.65 (n = 5,551; 95% confidence interval [CI] 1.26–2.16, p = 0.001) with an absolute risk (AR) increase of 2.5% for any leukoaraiosis vs none. The RR was 2.4 (n = 4,192; 95% CI 1.83–3.14, p = 0.001) with an AR increase of 6.2% for moderate to severe vs no to mild leukoaraiosis. For poor functional outcome; the RR was 1.30 (n = 3,401; 95% CI 1.19–1.42, p = 0.001) with an AR increase of 15.4% for any leukoaraiosis vs none. The RR was 1.31 (n = 3,659; 95% CI 1.22–1.42, p = 0.001) with an AR increase of 17.5% for moderate to severe vs no to mild leukoaraiosis. No statistical heterogeneity was noted for any of the analyses. Conclusions: Leukoaraiosis presence and severity are consistently associated with an increased risk of sICH and poor functional outcome after IV or intra-arterial thrombolysis for acute ischemic stroke.
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Affiliation(s)
- Kannikar Kongbunkiat
- From the Stroke Research Centre (K.K., D.W., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Division of Neurology, Department of Medicine, Faculty of Medicine (K.K., N.K., S.T.), and North-Eastern Stroke Research Group (K.K., N.K., S.T.), Khon Kaen University, Thailand; UCL School of Life & Medical Sciences (F.J.), London, UK; Stroke Unit (V.P.), Department of Neurology, Careggi University Hospital, Florence, Italy; Hotchkiss Brain Institute (M.D.H.), Cumming School of Medicine, University of Calgary, Canada; Radcliffe Department of Medicine (A.M.B.), University of Oxford, John Radcliffe Hospital, UK; Department of Neurology (S.J., H.P.M.), Inselspital, University of Bern, Switzerland; and Departments of Neurology and Psychiatry (N.H.), University of Massachusetts Medical School, Worcester
| | - Duncan Wilson
- From the Stroke Research Centre (K.K., D.W., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Division of Neurology, Department of Medicine, Faculty of Medicine (K.K., N.K., S.T.), and North-Eastern Stroke Research Group (K.K., N.K., S.T.), Khon Kaen University, Thailand; UCL School of Life & Medical Sciences (F.J.), London, UK; Stroke Unit (V.P.), Department of Neurology, Careggi University Hospital, Florence, Italy; Hotchkiss Brain Institute (M.D.H.), Cumming School of Medicine, University of Calgary, Canada; Radcliffe Department of Medicine (A.M.B.), University of Oxford, John Radcliffe Hospital, UK; Department of Neurology (S.J., H.P.M.), Inselspital, University of Bern, Switzerland; and Departments of Neurology and Psychiatry (N.H.), University of Massachusetts Medical School, Worcester
| | - Narongrit Kasemsap
- From the Stroke Research Centre (K.K., D.W., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Division of Neurology, Department of Medicine, Faculty of Medicine (K.K., N.K., S.T.), and North-Eastern Stroke Research Group (K.K., N.K., S.T.), Khon Kaen University, Thailand; UCL School of Life & Medical Sciences (F.J.), London, UK; Stroke Unit (V.P.), Department of Neurology, Careggi University Hospital, Florence, Italy; Hotchkiss Brain Institute (M.D.H.), Cumming School of Medicine, University of Calgary, Canada; Radcliffe Department of Medicine (A.M.B.), University of Oxford, John Radcliffe Hospital, UK; Department of Neurology (S.J., H.P.M.), Inselspital, University of Bern, Switzerland; and Departments of Neurology and Psychiatry (N.H.), University of Massachusetts Medical School, Worcester
| | - Somsak Tiamkao
- From the Stroke Research Centre (K.K., D.W., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Division of Neurology, Department of Medicine, Faculty of Medicine (K.K., N.K., S.T.), and North-Eastern Stroke Research Group (K.K., N.K., S.T.), Khon Kaen University, Thailand; UCL School of Life & Medical Sciences (F.J.), London, UK; Stroke Unit (V.P.), Department of Neurology, Careggi University Hospital, Florence, Italy; Hotchkiss Brain Institute (M.D.H.), Cumming School of Medicine, University of Calgary, Canada; Radcliffe Department of Medicine (A.M.B.), University of Oxford, John Radcliffe Hospital, UK; Department of Neurology (S.J., H.P.M.), Inselspital, University of Bern, Switzerland; and Departments of Neurology and Psychiatry (N.H.), University of Massachusetts Medical School, Worcester
| | - Fatima Jichi
- From the Stroke Research Centre (K.K., D.W., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Division of Neurology, Department of Medicine, Faculty of Medicine (K.K., N.K., S.T.), and North-Eastern Stroke Research Group (K.K., N.K., S.T.), Khon Kaen University, Thailand; UCL School of Life & Medical Sciences (F.J.), London, UK; Stroke Unit (V.P.), Department of Neurology, Careggi University Hospital, Florence, Italy; Hotchkiss Brain Institute (M.D.H.), Cumming School of Medicine, University of Calgary, Canada; Radcliffe Department of Medicine (A.M.B.), University of Oxford, John Radcliffe Hospital, UK; Department of Neurology (S.J., H.P.M.), Inselspital, University of Bern, Switzerland; and Departments of Neurology and Psychiatry (N.H.), University of Massachusetts Medical School, Worcester
| | - Vanessa Palumbo
- From the Stroke Research Centre (K.K., D.W., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Division of Neurology, Department of Medicine, Faculty of Medicine (K.K., N.K., S.T.), and North-Eastern Stroke Research Group (K.K., N.K., S.T.), Khon Kaen University, Thailand; UCL School of Life & Medical Sciences (F.J.), London, UK; Stroke Unit (V.P.), Department of Neurology, Careggi University Hospital, Florence, Italy; Hotchkiss Brain Institute (M.D.H.), Cumming School of Medicine, University of Calgary, Canada; Radcliffe Department of Medicine (A.M.B.), University of Oxford, John Radcliffe Hospital, UK; Department of Neurology (S.J., H.P.M.), Inselspital, University of Bern, Switzerland; and Departments of Neurology and Psychiatry (N.H.), University of Massachusetts Medical School, Worcester
| | - Michael D Hill
- From the Stroke Research Centre (K.K., D.W., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Division of Neurology, Department of Medicine, Faculty of Medicine (K.K., N.K., S.T.), and North-Eastern Stroke Research Group (K.K., N.K., S.T.), Khon Kaen University, Thailand; UCL School of Life & Medical Sciences (F.J.), London, UK; Stroke Unit (V.P.), Department of Neurology, Careggi University Hospital, Florence, Italy; Hotchkiss Brain Institute (M.D.H.), Cumming School of Medicine, University of Calgary, Canada; Radcliffe Department of Medicine (A.M.B.), University of Oxford, John Radcliffe Hospital, UK; Department of Neurology (S.J., H.P.M.), Inselspital, University of Bern, Switzerland; and Departments of Neurology and Psychiatry (N.H.), University of Massachusetts Medical School, Worcester
| | - Alastair M Buchan
- From the Stroke Research Centre (K.K., D.W., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Division of Neurology, Department of Medicine, Faculty of Medicine (K.K., N.K., S.T.), and North-Eastern Stroke Research Group (K.K., N.K., S.T.), Khon Kaen University, Thailand; UCL School of Life & Medical Sciences (F.J.), London, UK; Stroke Unit (V.P.), Department of Neurology, Careggi University Hospital, Florence, Italy; Hotchkiss Brain Institute (M.D.H.), Cumming School of Medicine, University of Calgary, Canada; Radcliffe Department of Medicine (A.M.B.), University of Oxford, John Radcliffe Hospital, UK; Department of Neurology (S.J., H.P.M.), Inselspital, University of Bern, Switzerland; and Departments of Neurology and Psychiatry (N.H.), University of Massachusetts Medical School, Worcester
| | - Simon Jung
- From the Stroke Research Centre (K.K., D.W., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Division of Neurology, Department of Medicine, Faculty of Medicine (K.K., N.K., S.T.), and North-Eastern Stroke Research Group (K.K., N.K., S.T.), Khon Kaen University, Thailand; UCL School of Life & Medical Sciences (F.J.), London, UK; Stroke Unit (V.P.), Department of Neurology, Careggi University Hospital, Florence, Italy; Hotchkiss Brain Institute (M.D.H.), Cumming School of Medicine, University of Calgary, Canada; Radcliffe Department of Medicine (A.M.B.), University of Oxford, John Radcliffe Hospital, UK; Department of Neurology (S.J., H.P.M.), Inselspital, University of Bern, Switzerland; and Departments of Neurology and Psychiatry (N.H.), University of Massachusetts Medical School, Worcester
| | - Heinrich P Mattle
- From the Stroke Research Centre (K.K., D.W., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Division of Neurology, Department of Medicine, Faculty of Medicine (K.K., N.K., S.T.), and North-Eastern Stroke Research Group (K.K., N.K., S.T.), Khon Kaen University, Thailand; UCL School of Life & Medical Sciences (F.J.), London, UK; Stroke Unit (V.P.), Department of Neurology, Careggi University Hospital, Florence, Italy; Hotchkiss Brain Institute (M.D.H.), Cumming School of Medicine, University of Calgary, Canada; Radcliffe Department of Medicine (A.M.B.), University of Oxford, John Radcliffe Hospital, UK; Department of Neurology (S.J., H.P.M.), Inselspital, University of Bern, Switzerland; and Departments of Neurology and Psychiatry (N.H.), University of Massachusetts Medical School, Worcester
| | - Nils Henninger
- From the Stroke Research Centre (K.K., D.W., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Division of Neurology, Department of Medicine, Faculty of Medicine (K.K., N.K., S.T.), and North-Eastern Stroke Research Group (K.K., N.K., S.T.), Khon Kaen University, Thailand; UCL School of Life & Medical Sciences (F.J.), London, UK; Stroke Unit (V.P.), Department of Neurology, Careggi University Hospital, Florence, Italy; Hotchkiss Brain Institute (M.D.H.), Cumming School of Medicine, University of Calgary, Canada; Radcliffe Department of Medicine (A.M.B.), University of Oxford, John Radcliffe Hospital, UK; Department of Neurology (S.J., H.P.M.), Inselspital, University of Bern, Switzerland; and Departments of Neurology and Psychiatry (N.H.), University of Massachusetts Medical School, Worcester
| | - David J Werring
- From the Stroke Research Centre (K.K., D.W., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Division of Neurology, Department of Medicine, Faculty of Medicine (K.K., N.K., S.T.), and North-Eastern Stroke Research Group (K.K., N.K., S.T.), Khon Kaen University, Thailand; UCL School of Life & Medical Sciences (F.J.), London, UK; Stroke Unit (V.P.), Department of Neurology, Careggi University Hospital, Florence, Italy; Hotchkiss Brain Institute (M.D.H.), Cumming School of Medicine, University of Calgary, Canada; Radcliffe Department of Medicine (A.M.B.), University of Oxford, John Radcliffe Hospital, UK; Department of Neurology (S.J., H.P.M.), Inselspital, University of Bern, Switzerland; and Departments of Neurology and Psychiatry (N.H.), University of Massachusetts Medical School, Worcester.
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Ryu WS, Woo SH, Schellingerhout D, Jang MU, Park KJ, Hong KS, Jeong SW, Na JY, Cho KH, Kim JT, Kim BJ, Han MK, Lee J, Cha JK, Kim DH, Lee SJ, Ko Y, Cho YJ, Lee BC, Yu KH, Oh MS, Park JM, Kang K, Lee KB, Park TH, Lee J, Choi HK, Lee K, Bae HJ, Kim DE. Stroke outcomes are worse with larger leukoaraiosis volumes. Brain 2016; 140:158-170. [PMID: 28008000 DOI: 10.1093/brain/aww259] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 08/16/2016] [Accepted: 09/02/2016] [Indexed: 12/11/2022] Open
Abstract
Leukoaraiosis or white matter hyperintensities are frequently observed on magnetic resonance imaging of stroke patients. We investigated how white matter hyperintensity volumes affect stroke outcomes, generally and by subtype. In total, 5035 acute ischaemic stroke patients were enrolled. Strokes were classified as large artery atherosclerosis, small vessel occlusion, or cardioembolism. White matter hyperintensity volumes were stratified into quintiles. Mean age (± standard deviation) was 66.3 ± 12.8, 59.6% male. Median (interquartile range) modified Rankin Scale score was 2 (1-3) at discharge and 1 (0-3) at 3 months; 16.5% experienced early neurological deterioration, and 3.3% recurrent stroke. The Cochran-Mantel-Haenszel test with adjustment for age, stroke severity, sex, and thrombolysis status showed that the distributions of 3-month modified Rankin Scale scores differed across white matter hyperintensity quintiles (P < 0.001). Multiple ordinal logistic regression analysis showed that higher white matter hyperintensity quintiles were independently associated with worse 3-month modified Rankin Scale scores; adjusted odds ratios (95% confidence interval) for the second to fifth quintiles versus the first quintile were 1.29 (1.10-1.52), 1.40 (1.18-1.66), 1.69 (1.42-2.02) and 2.03 (1.69-2.43), respectively. For large artery atherosclerosis (39.0%), outcomes varied by white matter hyperintensity volume (P = 0.01, Cochran-Mantel-Haenszel test), and the upper three white matter hyperintensity quintiles (versus the first quintile) had worse 3-month modified Rankin Scale scores; adjusted odds ratios were 1.45 (1.10-1.90), 1.86 (1.41-2.47), and 1.89 (1.41-2.54), respectively. Patients with large artery atherosclerosis were vulnerable to early neurological deterioration (19.4%), and the top two white matter hyperintensity quintiles were more vulnerable still: 23.5% and 22.3%. Moreover, higher white matter hyperintensities were associated with poor modified Rankin Scale improvement: adjusted odds ratios for the upper two quintiles versus the first quintile were 0.66 (0.47-0.94) and 0.62 (0.43-0.89), respectively. For small vessel occlusion (17.8%), outcomes tended to vary by white matter hyperintensitiy volume (P = 0.10, Cochran-Mantel-Haenszel test), and the highest quintile was associated with worse 3-month modified Rankin Scale scores: adjusted odds ratio for the fifth quintile versus first quintile, 1.98 (1.23-3.18). In this subtype, worse white matter hyperintensities were associated with worse National Institute of Health Stroke Scale scores at presentation. For cardioembolism (20.6%), outcomes did not vary significantly by white matter hyperintensity volume (P = 0.19, Cochran-Mantel-Haenszel test); however, the adjusted odds ratio for the highest versus lowest quintiles was 1.62 (1.09-2.40). Regardless of stroke subtype, white matter hyperintensities were not associated with stroke recurrence within 3 months of follow-up. In conclusion, white matter hyperintensity volume independently correlates with stroke outcomes in acute ischaemic stroke. There are some suggestions that stroke outcomes may be affected by leukoaraiosis differentially depending on stroke subtypes, to be confirmed in future investigations.
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Affiliation(s)
- Wi-Sun Ryu
- 1 Stroke Centre and Korean Brain MRI Data Centre, Dongguk University Ilsan Hospital, Korea
| | - Sung-Ho Woo
- 1 Stroke Centre and Korean Brain MRI Data Centre, Dongguk University Ilsan Hospital, Korea
| | - Dawid Schellingerhout
- 2 Departments of Radiology and Cancer Systems Imaging, University of Texas M. D. Anderson Cancer Centre, USA
| | - Min Uk Jang
- 3 Department of Neurology, Chuncheon Sacred Heart Hospital, Korea
| | | | - Keun-Sik Hong
- 5 Department of Neurology, Ilsan Paik Hospital, Korea
| | - Sang-Wuk Jeong
- 1 Stroke Centre and Korean Brain MRI Data Centre, Dongguk University Ilsan Hospital, Korea
| | - Jeong-Yong Na
- 1 Stroke Centre and Korean Brain MRI Data Centre, Dongguk University Ilsan Hospital, Korea
| | - Ki-Hyun Cho
- 6 Department of Neurology, Chonnam National University Hospital, Korea
| | - Joon-Tae Kim
- 6 Department of Neurology, Chonnam National University Hospital, Korea
| | - Beom Joon Kim
- 7 Department of Neurology, Seoul National University Bundang Hospital, Korea
| | - Moon-Ku Han
- 7 Department of Neurology, Seoul National University Bundang Hospital, Korea
| | - Jun Lee
- 8 Department of Neurology, Yeungnam University Hospital, Korea
| | - Jae-Kwan Cha
- 9 Department of Neurology, Dong-A University Hospital, Korea
| | - Dae-Hyun Kim
- 9 Department of Neurology, Dong-A University Hospital, Korea
| | - Soo Joo Lee
- 10 Department of Neurology, Eulji University Hospital, Korea
| | - Youngchai Ko
- 10 Department of Neurology, Eulji University Hospital, Korea
| | - Yong-Jin Cho
- 5 Department of Neurology, Ilsan Paik Hospital, Korea
| | - Byung-Chul Lee
- 11 Department of Neurology, Hallym University Sacred Heart Hospital, Korea
| | - Kyung-Ho Yu
- 11 Department of Neurology, Hallym University Sacred Heart Hospital, Korea
| | - Mi Sun Oh
- 11 Department of Neurology, Hallym University Sacred Heart Hospital, Korea
| | - Jong-Moo Park
- 12 Department of Neurology, Eulji General Hospital, Korea
| | - Kyusik Kang
- 12 Department of Neurology, Eulji General Hospital, Korea
| | - Kyung Bok Lee
- 13 Department of Neurology, Soonchunhyang University Hospital, Korea
| | - Tai Hwan Park
- 14 Department of Neurology, Seoul Medical Centre, Korea
| | - Juneyoung Lee
- 15 Department of Biostatistics, Korea University College of Medicine, Korea
| | | | - Kiwon Lee
- 17 Departments of Neurology and Neurosurgery, The University of Texas Health Science Centre, USA
| | - Hee-Joon Bae
- 7 Department of Neurology, Seoul National University Bundang Hospital, Korea
| | - Dong-Eog Kim
- 1 Stroke Centre and Korean Brain MRI Data Centre, Dongguk University Ilsan Hospital, Korea
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Hyperfibrinolysis increases blood–brain barrier permeability by a plasmin- and bradykinin-dependent mechanism. Blood 2016; 128:2423-2434. [DOI: 10.1182/blood-2016-03-705384] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 08/06/2016] [Indexed: 11/20/2022] Open
Abstract
Key Points
Hydrodynamic transfection of plasmids encoding for plasminogen activators leads to a hyperfibrinolytic state in mice. Hyperfibrinolysis increases BBB permeability via a plasmin- and bradykinin-dependent mechanism.
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Tejada-Meza H, Modrego PJ. Cerebellar vermis: a vulnerable location of remote brain haemorrhages after thrombolysis for ischaemic stroke. Neurol Sci 2016; 38:185-187. [PMID: 27709302 DOI: 10.1007/s10072-016-2728-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 10/03/2016] [Indexed: 10/20/2022]
Abstract
Extra-ischaemic (remote) brain heamorrhages after thrombolysis for ischaemic stroke occur in less than 3 % of treated patients, but it worsens prognosis. Little attention has been paid to the location of the haematomas. Among 12 patients with remote brain haemorrhage after thrombolysis, we report three patients with haemorrhage in the cerebellar vermis (25 %), with poor outcome. Previous hypertensive vasculopathy is deemed to be the most plausible cause.
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Affiliation(s)
| | - Pedro J Modrego
- Department of Neurology, Hospital Miguel Servet, 50009, Saragossa, Spain.
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Curtze S, Sibolt G, Melkas S, Mustanoja S, Haapaniemi E, Putaala J, Sairanen T, Tiainen M, Tatlisumak T, Strbian D. Symptomatic post-thrombolytic intracerebral hemorrhage is not related to the cause of stroke. Eur J Neurol 2016; 23:1700-1704. [DOI: 10.1111/ene.13128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 08/09/2016] [Indexed: 11/30/2022]
Affiliation(s)
- S. Curtze
- Clinical Neurosciences; Neurology; University of Helsinki; Helsinki
- Department of Neurology; Helsinki University Hospital; Helsinki Finland
| | - G. Sibolt
- Clinical Neurosciences; Neurology; University of Helsinki; Helsinki
- Department of Neurology; Helsinki University Hospital; Helsinki Finland
| | - S. Melkas
- Clinical Neurosciences; Neurology; University of Helsinki; Helsinki
- Department of Neurology; Helsinki University Hospital; Helsinki Finland
| | - S. Mustanoja
- Clinical Neurosciences; Neurology; University of Helsinki; Helsinki
- Department of Neurology; Helsinki University Hospital; Helsinki Finland
| | - E. Haapaniemi
- Clinical Neurosciences; Neurology; University of Helsinki; Helsinki
- Department of Neurology; Helsinki University Hospital; Helsinki Finland
| | - J. Putaala
- Clinical Neurosciences; Neurology; University of Helsinki; Helsinki
- Department of Neurology; Helsinki University Hospital; Helsinki Finland
| | - T. Sairanen
- Clinical Neurosciences; Neurology; University of Helsinki; Helsinki
- Department of Neurology; Helsinki University Hospital; Helsinki Finland
| | - M. Tiainen
- Clinical Neurosciences; Neurology; University of Helsinki; Helsinki
- Department of Neurology; Helsinki University Hospital; Helsinki Finland
| | - T. Tatlisumak
- Clinical Neurosciences; Neurology; University of Helsinki; Helsinki
- Department of Neurology; Helsinki University Hospital; Helsinki Finland
- Institute of Neuroscience and Physiology; Salhgrenska Academy at University of Gothenburg; Gothenburg
- Department of Neurology; Sahlgrenska University Hospital; Gothenburg Sweden
| | - D. Strbian
- Clinical Neurosciences; Neurology; University of Helsinki; Helsinki
- Department of Neurology; Helsinki University Hospital; Helsinki Finland
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Pryzdial ELG, Meixner SC, Talbot K, Eltringham-Smith LJ, Baylis JR, Lee FMH, Kastrup CJ, Sheffield WP. Thrombolysis by chemically modified coagulation factor Xa. J Thromb Haemost 2016; 14:1844-54. [PMID: 27359348 PMCID: PMC5576980 DOI: 10.1111/jth.13402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 06/15/2016] [Indexed: 12/22/2022]
Abstract
UNLABELLED Essentials Factor Xa (FXa) acquires cleavage-mediated tissue plasminogen activator (tPA) cofactor activity. Recombinant (r) tPA is the predominant thrombolytic drug, but it may cause systemic side effects. Chemically modified, non-enzymatic FXa was produced (Xai-K), which rapidly lysed thrombi in mice. Unlike rtPA, Xai-K had no systemic fibrinolysis activation markers, indicating improved safety. SUMMARY Background Enzymatic thrombolysis carries the risk of hemorrhage and re-occlusion must be evaded by co-administration with an anticoagulant. Toward further improving these shortcomings, we report a novel dual-functioning molecule, Xai-K, which is both a non-enzymatic thrombolytic agent and an anticoagulant. Xai-K is based on clotting factor Xa, whose sequential plasmin-mediated fragments, FXaβ and Xa33/13, accelerate the principal thrombolytic agent, tissue plasminogen activator (tPA), but only when localized to anionic phospholipid. Methods The effect of Xai-K on fibrinolysis was measured in vitro by turbidity, thromboelastography and chromogenic assays, and measured in a murine model of occlusive carotid thrombosis by Doppler ultrasound. The anticoagulant properties of Xai-K were evaluated by normal plasma clotting assays, and in murine liver laceration and tail amputation hemostatic models. Results Xa33/13, which participates in fibrinolysis of purified fibrin, was rapidly inhibited in plasma. Cleavage was blocked at FXaβ by modifying residues at the active site. The resultant Xai-K (1 nm) enhanced plasma clot dissolution by ~7-fold in vitro and was dependent on tPA. Xai-K alone (2.0 μg g(-1) body weight) achieved therapeutic patency in mice. The minimum primary dose of the tPA variant, Tenecteplase (TNK; 17 μg g(-1) ), could be reduced by > 30-fold to restore blood flow with adjunctive Xai-K (0.5 μg g(-1) ). TNK-induced systemic markers of fibrinolysis were not detected with Xai-K (2.0 μg g(-1) ). Xai-K had anticoagulant activity that was somewhat attenuated compared with a previously reported analogue. Conclusion These results suggest that Xai-K may ameliorate the safety profile of therapeutic thrombolysis, either as a primary or tPA/TNK-adjunctive agent.
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Affiliation(s)
- E L G Pryzdial
- Centre for Blood Research and Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.
- Centre for Innovation, Canadian Blood Services, Ottawa, ON, Canada.
| | - S C Meixner
- Centre for Blood Research and Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Innovation, Canadian Blood Services, Ottawa, ON, Canada
| | - K Talbot
- Centre for Blood Research and Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Innovation, Canadian Blood Services, Ottawa, ON, Canada
| | - L J Eltringham-Smith
- Centre for Innovation, Canadian Blood Services, Ottawa, ON, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - J R Baylis
- Centre for Blood Research and Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- Michael Smith Laboratories and Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, BC, Canada
| | - F M H Lee
- Centre for Blood Research and Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Innovation, Canadian Blood Services, Ottawa, ON, Canada
| | - C J Kastrup
- Centre for Blood Research and Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- Michael Smith Laboratories and Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, BC, Canada
| | - W P Sheffield
- Centre for Innovation, Canadian Blood Services, Ottawa, ON, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
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Prats-Sánchez L, Camps-Renom P, Sotoca-Fernández J, Delgado-Mederos R, Martínez-Domeño A, Marín R, Almendrote M, Dorado L, Gomis M, Codas J, Llull L, Gómez González A, Roquer J, Purroy F, Gómez-Choco M, Cánovas D, Cocho D, Garces M, Abilleira S, Martí-Fàbregas J. Remote Intracerebral Hemorrhage After Intravenous Thrombolysis. Stroke 2016; 47:2003-9. [DOI: 10.1161/strokeaha.116.013952] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 06/07/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Remote parenchymal hemorrhage (rPH) after intravenous thrombolysis with recombinant tissue-type plasminogen activator may be associated with cerebral amyloid angiopathy, although supportive data are limited. We aimed to investigate risk factors of rPH after intravenous thrombolysis with recombinant tissue-type plasminogen activator.
Methods—
This is an observational study of patients with ischemic stroke who were treated with intravenous thrombolysis with recombinant tissue-type plasminogen activator and were included in a multicenter prospective registry. rPH was defined as any extraischemic hemorrhage detected in the follow-up computed tomography. We collected demographic, clinical, laboratory, radiological, and outcome variables. In the subset of patients who underwent a magnetic resonance imaging examination, we evaluated the distribution and burden of cerebral microbleeds, cortical superficial siderosis, leukoaraiosis, and recent silent ischemia in regions anatomically unrelated to the ischemic lesion that caused the initial symptoms. We compared patients with rPH with those without rPH or parenchymal hemorrhage. Independent risk factors for rPH were obtained by multivariable logistic regression analyses.
Results—
We evaluated 992 patients (mean age, 74.0±12.6 years; 52.9% were men), and 408 (41%) of them underwent a magnetic resonance imaging. Twenty-six patients (2.6%) had a rPH, 8 (0.8%) had both rPH and PH, 58 (5.8%) had PH, and 900 (90.7%) had no bleeding complication. Lobar cerebral microbleeds (odds ratio, 8.0; 95% confidence interval, 2.3–27.2) and recent silent ischemia (odds ratio, 4.8; 95% confidence interval, 1.6–14.1) increased the risk of rPH.
Conclusions—
The occurrence of rPH after intravenous thrombolysis with recombinant tissue-type plasminogen activator in patients with ischemic stroke is associated with lobar cerebral microbleeds and multiple ischemic lesions in different regions.
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Affiliation(s)
- Luis Prats-Sánchez
- From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G
| | - Pol Camps-Renom
- From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G
| | - Javier Sotoca-Fernández
- From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G
| | - Raquel Delgado-Mederos
- From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G
| | - Alejandro Martínez-Domeño
- From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G
| | - Rebeca Marín
- From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G
| | - Miriam Almendrote
- From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G
| | - Laura Dorado
- From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G
| | - Meritxell Gomis
- From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G
| | - Javier Codas
- From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G
| | - Laura Llull
- From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G
| | - Alejandra Gómez González
- From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G
| | - Jaume Roquer
- From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G
| | - Francisco Purroy
- From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G
| | - Manuel Gómez-Choco
- From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G
| | - David Cánovas
- From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G
| | - Dolores Cocho
- From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G
| | - Moises Garces
- From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G
| | - Sonia Abilleira
- From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G
| | - Joan Martí-Fàbregas
- From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G
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Kiechl S, Willeit J. Alteplase in acute ischaemic stroke: no time to slow down. Lancet Neurol 2016; 15:893-895. [DOI: 10.1016/s1474-4422(16)30095-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 05/17/2016] [Indexed: 11/26/2022]
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