Key result
ICA occlusion is not associated with higher intracerebral hemorrhage risk after t-PA vs other arterial occlusions.
Why the study?
ICA occlusion is considered a severe stroke and is thought to frequently have intracerebral hemorrhage after t-PA therapy, but its frequency compared with other occluded arteries was unclear.
Does ICA occlusion increase the frequency of intracerebral hemorrhage after IV t-PA therapy for ischemic stroke compared to other occluded arteries?
Cohort (n=165)
Does ICA occlusion increase the frequency of intracerebral hemorrhage after IV t-PA therapy for ischemic stroke compared to other occluded arteries?
ICA occlusion does not appear to increase the risk of intracerebral hemorrhage following IV t-PA therapy for ischemic stroke compared to other arterial occlusions.
ICA occlusion was not associated with higher post-t-PA ICH rates; leaves open confirmation in prospective cohorts.
Background/Aims: The main predictors of intracerebral hemorrhage (ICH) are clinical stroke severity and large ischemic lesions. Therefore, ICA occlusion as severe stroke is thought to frequently have ICH after tissue plasminogen activator (t-PA) therapy. The aim of this study was to investigate whether ICA occlusion more frequently had ICH after t-PA therapy compared with other occluded arteries. Subjects andMethods: We prospectively studied consecutive stroke patients treated with t-PA within 3 h of onset. We investigated the frequency of ICH after t-PA therapy for each occluded artery. Results: 165 patients were enrolled. Initial MRA demonstrated ICA occlusion in 38 patients, M1 in 48, M2 in 28, and BA and PCA in 12. At 24 h after t-PA infusion, 113 (68.5%) patients (non-HT group) did not have hemorrhagic transformation, 37 (22.4%; HI group) had hemorrhagic cerebral infarction and 15 (9.1%; ICH group) had ICH. The ICH group most frequently had M2 occlusion, NIHSS ≧15, and ≧1/3 of the MCA territory among the three groups. The frequency of ICH was 2.6% in no occlusion, 10.5% in ICA occlusion, 6.3% in M1, 21.4% in M2, and 8.3% in PCA and BA (p = 0.1016). Conclusion: Patients with ICA occlusion did not have ICH more frequently after t-PA therapy in comparison to other occluded arteries.
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Kimura et al. (2011) conducted a cohort in Ischemic Stroke (n=165). ICA occlusion vs. Other occluded arteries (M1, M2, PCA, BA, or no occlusion) was evaluated on Intracerebral hemorrhage (ICH) at 24 hours (p=0.1016). ICA occlusion was not associated with a significantly higher frequency of intracerebral hemorrhage 24 hours after t-PA therapy compared to other occluded arteries (10.5%, p=0.1016).
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