Document Detail


Recanalization between 1 and 24 hours after t-PA therapy is a strong predictor of cerebral hemorrhage in acute ischemic stroke patients.
MedLine Citation:
PMID:  18304581     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: Intravenous administration of tissue plasminogen activator (t-PA) can improve clinical outcomes in patients with acute ischemic stroke. The most important complication of t-PA therapy is intracerebral hemorrhage (ICH). The aim of this study was to use serial MRI studies to identify independent predictors of symptomatic and asymptomatic ICH after t-PA therapy. METHODS: Consecutive anterior-circulation ischemic stroke patients treated with t-PA within 3 h of stroke onset were studied prospectively. To identify the presence of recanalization in the occluded arteries and the presence of ICH, MRI, including diffusion weighted imaging (DWI), T2*, and magnetic resonance angiography (MRA), was performed before and 1 h, 24 h, and 5-7 days after t-PA thrombolysis. The independent predictors of ICH were determined using multivariate logistic regression analysis. RESULTS: 41 patients (21 males, 20 females; mean age, 73.2+/-10.7 years) were enrolled, and 19 ICHs (1 symptomatic, 18 asymptomatic) were observed on T2*. The initial MRA demonstrated occluded brain arteries in 31 patients (75.6%), of which follow-up MRA at 1 h, 24 h, and 5-7 days after t-PA therapy revealed recanalization in 48.4%, 80.0%, and 90.0% of patients, respectively. The frequency of recanalization within 1 h after t-PA therapy did not differ between ICH and No-ICH groups, but the ICH group had more frequent recanalization between 1 h and 24 h after t-PA than the No-ICH group (50.0% vs. 4.5%, P=0.001). The ICH group had arterial fibrillation (AF) more frequently than the No-ICH group (78.9% vs. 27.3%, P=0.001). Compared to the No-ICH group, the NIHSS score was higher (16.4+/-5.7 vs. 11.5+/-6.5, P=0.011) and the ASPECTS-DWI value (a normal DWI has an ASPECTS-DWI value of 11 points) was lower (7.3+/-2.4 vs. 8.9+/-1.9, P=0.019) in the ICH group. Multivariate logistic regression analysis demonstrated that the presence of recanalization between 1 and 24 h after the end of t-PA infusion (OR: 20.2; CI: 1.0-340.9; P=0.037) was the only independent predictor of ICH. CONCLUSION: Recanalization of occluded arteries between 1 and 24 h but not within 1 h after t-PA infusion should be independently associated with symptomatic and asymptomatic ICH after t-PA therapy.
Authors:
Kazumi Kimura; Yasuyuki Iguchi; Kensaku Shibazaki; Kazuto Kobayashi; Junichi Uemura; Junya Aoki; Shinji Yamashita; Yuka Terasawa; Noriko Matsumoto
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-03-04
Journal Detail:
Title:  Journal of the neurological sciences     Volume:  270     ISSN:  0022-510X     ISO Abbreviation:  J. Neurol. Sci.     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-06-09     Completed Date:  2008-09-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0375403     Medline TA:  J Neurol Sci     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  48-52     Citation Subset:  IM    
Affiliation:
Department of Stroke Medicine, Kawasaki Medical School, Japan. kimurak@med.kawasaki-m.ac.jp
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Cerebral Hemorrhage / chemically induced*
Diffusion Magnetic Resonance Imaging / methods
Female
Fibrinolytic Agents / administration & dosage,  adverse effects*
Humans
Injections, Intravenous
Logistic Models
Magnetic Resonance Angiography / methods
Male
Predictive Value of Tests
Prospective Studies
Retrospective Studies
Stroke / drug therapy*,  physiopathology
Time Factors
Tissue Plasminogen Activator / administration & dosage,  adverse effects*
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents; EC 3.4.21.68/Tissue Plasminogen Activator

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