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Pan X, Pei Y, Zhang M, Zhong W, Hu J, Wang Z, Xu D, Lou M, Chen H, Chen Z. Association of Atrial Fibrillation with Remote Intracerebral Hemorrhage After Intravenous Thrombolysis: Results from a Multicenter Study in China. Neurol Ther 2024; 13:127-139. [PMID: 38032536 PMCID: PMC10787712 DOI: 10.1007/s40120-023-00563-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION This study aimed to investigate the association between atrial fibrillation (AF), particularly newly diagnosed AF, and remote intracerebral hemorrhage (rICH) in patients with ischemic stroke who were treated with intravenous thrombolysis (IVT). METHODS This observational study was conducted on patients with ischemic stroke who received IVT with recombinant tissue-type plasminogen activator. The data were taken from a multicenter prospective registry of a Chinese population. rICH was defined as any extraischemic hemorrhage detected on computerized tomography (CT) 24 h after intravenous thrombolysis. We collected and compared the demographic data and clinical characteristics of all the patients with rICH to those of patients without any type of hemorrhagic transformation. The association between AF and rICH was analyzed using univariate analysis and binary logistic regression. RESULTS A total of 20,697 patients were included in the study, with 1566 (7.6%) experiencing intracerebral hemorrhage (ICH), 586 (2.8%) experiencing rICH, and 19,131 (92.4%) not experiencing any form of hemorrhagic transformation. Univariate analysis revealed significant differences in age, pre-thrombolysis systolic blood pressure, baseline National Institute of Health Stroke Scale score, previously known AF, newly diagnosed AF, coronary heart disease, congestive heart failure, hyperhomocysteinemia, and history of thrombolysis between the rICH and control groups (P < 0.05). Further multivariate logistic regression analysis indicated that total AF (OR 1.821, 95% CI 1.082-3.065, P < 0.05), previously known AF (OR 1.470, 95% CI 1.170-1.847), and newly diagnosed AF (OR 1.920, 95% CI 1.304-2.825) were independently associated with rICH. CONCLUSIONS This study suggests that AF, regardless of whether it is newly diagnosed or previously known, may be associated with the occurrence of rICH following intravenous thrombolysis. Interestingly, our findings suggest that newly diagnosed AF may have a stronger impact on rICH than previously known AF, although confirmation from more studies is needed.
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Affiliation(s)
- Xiaoling Pan
- Department of Neurology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua Municipal Central Hospital, No. 365 Renmin East Road, Jinhua, 321000, Zhejiang Province, China
| | - Yingjian Pei
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China
| | - Meixia Zhang
- Department of Neurology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua Municipal Central Hospital, No. 365 Renmin East Road, Jinhua, 321000, Zhejiang Province, China
| | - Wansi Zhong
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China
| | - Jin Hu
- Department of Neurology, The First Hospital of Jiaxing, Jiaxing, 314000, Zhejiang Province, China
| | - Zhimin Wang
- Department of Neurology, Taizhou First People's Hospital, Taizhou, 318020, Zhejiang Province, China
| | - Dongjuan Xu
- Department of Neurology, Dongyang People's Hospital, Dongyang, 322100, Zhejiang Province, China
| | - Min Lou
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China
| | - Hongfang Chen
- Department of Neurology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua Municipal Central Hospital, No. 365 Renmin East Road, Jinhua, 321000, Zhejiang Province, China.
| | - Zhicai Chen
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China.
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Wang Y, Bai X, Ye C, Yu Y, Wu B. The association between the severity and distribution of white matter lesions and hemorrhagic transformation after ischemic stroke: A systematic review and meta-analysis. Front Aging Neurosci 2022; 14:1053149. [PMID: 36506465 PMCID: PMC9732368 DOI: 10.3389/fnagi.2022.1053149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/04/2022] [Indexed: 11/27/2022] Open
Abstract
Background and purpose As a part of the natural course of ischemic stroke, hemorrhagic transformation (HT) is a serious complication after reperfusion treatment, which may affect the prognosis of patients with ischemic stroke. White matter lesions (WMLs) refer to focal lesions on neuroimaging and have been suggested to indicate a high risk of HT. This systematic review and meta-analysis aimed to summarize current evidence on the relation between WML and HT. Methods This systematic review was prepared with reference to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched PubMed, Embase, Web of Science, and Cochrane Library databases for publications on WML and HT in patients with ischemic stroke. Odds ratios (ORs) and 95% confidence intervals (CIs) from eligible studies were combined to quantify the association between the severity of WML and the risk of HT. In addition, the descriptive analysis was adopted to evaluate the influence of different WML distributions on predicting HT. Results A total of 2,303 articles were identified after removing duplicates through database searching, and 41 studies were included in our final analysis. The meta-analysis showed that the presence of WML was associated with HT (OR = 1.62, 95%CI 1.08-2.43, p = 0.019) and symptomatic intracerebral hemorrhage (sICH) (OR = 1.64, 95%CI 1.17-2.30, p = 0.004), and moderate-to-severe WML indicated a high risk of HT (OR = 2.03, 95%CI 1.33-3.12, p = 0.001) and sICH (OR = 1.92, 95%CI 1.31-2.81, p < 0.001). The dose-response meta-analysis revealed risk effects of increasing the severity of WML on both HT and ICH. In addition, both periventricular WML (PWML) (five of seven articles) and deep WML (DWML) (five of six articles) were shown to be associated with HT. Conclusions White matter lesions are associated with overall HT and sICH in patients with ischemic stroke, and more severe WMLs indicate a high risk of HT and sICH. In addition, both PWML and DWMLs could be risk factors for HT. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier: PROSPERO CRD42022313467.
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Affiliation(s)
- Youjie Wang
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Xueling Bai
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Chen Ye
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yifan Yu
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Bo Wu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Bo Wu
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Elucidating the Role of Baseline Leukoaraiosis on Forecasting Clinical Outcome of Acute Ischemic Stroke Patients Undergoing Reperfusion Therapy. Neurol Int 2022; 14:923-942. [PMID: 36412696 PMCID: PMC9680372 DOI: 10.3390/neurolint14040074] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/06/2022] [Accepted: 11/08/2022] [Indexed: 11/12/2022] Open
Abstract
Stroke stands as a major cause of death and disability with increasing prevalence. The absence of clinical improvement after either intravenous thrombolysis (IVT) or mechanical thrombectomy (MT) represents a frequent concern in the setting of acute ischemic stroke (AIS). In an attempt to optimize overall stroke management, it is clinically valuable to provide important insight into functional outcomes after reperfusion therapy among patients presenting with AIS. The aim of the present review is to explore the predictive value of leukoaraiosis (LA) in terms of clinical response to revascularization poststroke. A literature research of two databases (MEDLINE and Scopus) was conducted in order to trace all relevant studies published between 1 January 2012 and 1 November 2022 that focused on the potential utility of LA severity regarding reperfusion status and clinical outcome after revascularization. A total of 37 articles have been traced and included in this review. LA burden assessment is indicative of functional outcome post-intervention and may be associated with hemorrhagic events' incidence among stroke individuals. Nevertheless, LA may not solely guide decision-making about treatment strategy poststroke. Overall, the evaluation of LA upon admission seems to have interesting prognostic potential and may substantially enhance individualized stroke care.
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Renard D, Castelnovo G, Ion I, Guillamo JS, Thouvenot E. Single and simultaneous multiple intracerebral hemorrhages: a radiological review. Acta Neurol Belg 2020; 120:819-829. [PMID: 32449137 DOI: 10.1007/s13760-020-01385-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 05/14/2020] [Indexed: 01/11/2023]
Abstract
Simultaneous multiple intracerebral hemorrhage (SMICH) is defined as ICH in two or more discrete noncontiguous acute intraparenchymal locations on initial CT. About 5% of ICH patients present with SMICH. ICH/SMICH etiology is classically divided into disorders of primary or secondary origin. About half of primary SMICH cases are caused by cerebral amyloid angiopathy or hypertensive arteriopathy. In this review, we will discuss the radiological features associated with the different causes of primary and secondary ICH and SMICH. Due to its rarity and the associated high morbidity and mortality, we will focus in particular on SMICH.
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Affiliation(s)
- Dimitri Renard
- Department of Neurology, CHU Nîmes, Hôpital Caremeau, University of Montpellier, 4, Rue Du Pr Debré, 30029, Nîmes Cedex 4, France.
| | - Giovanni Castelnovo
- Department of Neurology, CHU Nîmes, Hôpital Caremeau, University of Montpellier, 4, Rue Du Pr Debré, 30029, Nîmes Cedex 4, France
| | - Ioana Ion
- Department of Neurology, CHU Nîmes, Hôpital Caremeau, University of Montpellier, 4, Rue Du Pr Debré, 30029, Nîmes Cedex 4, France
| | - Jean Sebastien Guillamo
- Department of Neurology, CHU Nîmes, Hôpital Caremeau, University of Montpellier, 4, Rue Du Pr Debré, 30029, Nîmes Cedex 4, France
| | - Eric Thouvenot
- Department of Neurology, CHU Nîmes, Hôpital Caremeau, University of Montpellier, 4, Rue Du Pr Debré, 30029, Nîmes Cedex 4, France
- Institut de Génomique Fonctionnelle, UMR 5203, INSERM 1191, Université Montpellier, Montpellier, France
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Drelon A, Kuchcinski G, Caparros F, Dequatre-Ponchelle N, Moulin S, Cordonnier C, Bordet R, Pruvo JP, Leys D. Remote brain hemorrhage after IV thrombolysis: Role of preexisting lesions. Neurology 2019; 94:e961-e967. [PMID: 31882531 DOI: 10.1212/wnl.0000000000008874] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 08/30/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test the hypothesis that remote intracerebral hemorrhages (r-ICHs) after IV thrombolysis occur in preexisting brain lesions. METHOD We prospectively collected baseline data from consecutive patients treated with IV thrombolysis for cerebral ischemia and reviewed their baseline MRI scans to identify preexisting lesions in those who developed r-ICH. We evaluated outcomes with the modified Rankin Scale (mRS) and defined good outcomes as scores of 0 to 2 or similar to the preexisting mRS score. RESULTS Of 944 patients, 24 (2.5%) had r-ICH: lobar in 14, deep in 7, and both in 3. Sixteen of them (1.7% of all patients, 66.7% of those with r-ICH) were asymptomatic. Of the 41 r-ICHs found in these patients, 17 (41%) occurred within a lesion present before thrombolysis: 6 cerebral microbleeds (CMBs), 6 old and 1 recent infarct, and 4 areas of white matter hyperintensity. Patients with r-ICH were more likely to have strictly lobar CMBs (p = 0.049). They were 10 years older (p = 0.007), had a 16-mm Hg higher systolic blood pressure (p = 0.035) at baseline, and had more CMBs (p = 0.007). r-ICHs were better predicted by clinical (age, baseline systolic blood pressure) than imaging (purely lobar CMBs and having >5 CMBs) variables. r-ICHs tended to be associated with worse outcomes. CONCLUSION We identified preexisting brain lesions in nearly half of the patients with r-ICH. All were of vascular origin, supporting the hypothesis that r-ICHs occur in preexisting brain lesions. Higher-field machines could help identifying preexisting lesions in those who developed r-ICH in an apparently normal area.
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Affiliation(s)
- Agathe Drelon
- From the Departments of Neurology (A.D., F.C., N.D.-P., S.M., C.C., D.L.), Neuroradiology (G.K., J.-P.P.), and Clinical Pharmacology (R.B.), University of Lille, Inserm U1171, CHU Lille, France
| | - Gregory Kuchcinski
- From the Departments of Neurology (A.D., F.C., N.D.-P., S.M., C.C., D.L.), Neuroradiology (G.K., J.-P.P.), and Clinical Pharmacology (R.B.), University of Lille, Inserm U1171, CHU Lille, France
| | - François Caparros
- From the Departments of Neurology (A.D., F.C., N.D.-P., S.M., C.C., D.L.), Neuroradiology (G.K., J.-P.P.), and Clinical Pharmacology (R.B.), University of Lille, Inserm U1171, CHU Lille, France
| | - Nelly Dequatre-Ponchelle
- From the Departments of Neurology (A.D., F.C., N.D.-P., S.M., C.C., D.L.), Neuroradiology (G.K., J.-P.P.), and Clinical Pharmacology (R.B.), University of Lille, Inserm U1171, CHU Lille, France
| | - Solène Moulin
- From the Departments of Neurology (A.D., F.C., N.D.-P., S.M., C.C., D.L.), Neuroradiology (G.K., J.-P.P.), and Clinical Pharmacology (R.B.), University of Lille, Inserm U1171, CHU Lille, France
| | - Charlotte Cordonnier
- From the Departments of Neurology (A.D., F.C., N.D.-P., S.M., C.C., D.L.), Neuroradiology (G.K., J.-P.P.), and Clinical Pharmacology (R.B.), University of Lille, Inserm U1171, CHU Lille, France
| | - Régis Bordet
- From the Departments of Neurology (A.D., F.C., N.D.-P., S.M., C.C., D.L.), Neuroradiology (G.K., J.-P.P.), and Clinical Pharmacology (R.B.), University of Lille, Inserm U1171, CHU Lille, France
| | - Jean-Pierre Pruvo
- From the Departments of Neurology (A.D., F.C., N.D.-P., S.M., C.C., D.L.), Neuroradiology (G.K., J.-P.P.), and Clinical Pharmacology (R.B.), University of Lille, Inserm U1171, CHU Lille, France
| | - Didier Leys
- From the Departments of Neurology (A.D., F.C., N.D.-P., S.M., C.C., D.L.), Neuroradiology (G.K., J.-P.P.), and Clinical Pharmacology (R.B.), University of Lille, Inserm U1171, CHU Lille, France.
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Sigüenza González R, Gómez San Martín E. Amyloid angiopathy as a cause of “intracranial remote haemorrhage” in a patient treated with fibrinolysis. RADIOLOGIA 2019. [DOI: 10.1016/j.rxeng.2018.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Angiopatía amiloide como causa de “hemorragia intracraneal remota” en paciente tratado mediante fibrinólisis. RADIOLOGIA 2019; 61:266-268. [DOI: 10.1016/j.rx.2018.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 08/03/2018] [Accepted: 08/10/2018] [Indexed: 11/20/2022]
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Charidimou A, Pasi M. Microbleeds evolution and remote hemorrhage post-tPA: "Red meets white" revisited. Neurology 2019; 92:307-308. [PMID: 30674598 DOI: 10.1212/wnl.0000000000006933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Andreas Charidimou
- From The J. Philip Kistler Stroke Research Center, Department of Neurology (A.C.), Massachusetts General Hospital; Hemorrhagic Stroke Research Program (A.C.), Massachusetts General Hospital, Harvard Medical School, Boston; and Department of Neurology (M.P.), University of Lille, Centre Hospitalier Universitaire Lille, France.
| | - Marco Pasi
- From The J. Philip Kistler Stroke Research Center, Department of Neurology (A.C.), Massachusetts General Hospital; Hemorrhagic Stroke Research Program (A.C.), Massachusetts General Hospital, Harvard Medical School, Boston; and Department of Neurology (M.P.), University of Lille, Centre Hospitalier Universitaire Lille, France
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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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