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(Stroke. 2006;37:2526.)
© 2006 American Heart Association, Inc.

Original Contributions

Reduced Pretreatment Ipsilateral Middle Cerebral Artery Cerebral Blood Flow Is Predictive of Symptomatic Hemorrhage Post–Intra-Arterial Thrombolysis in Patients With Middle Cerebral Artery Occlusion

Rishi Gupta, MD; Howard Yonas, MD; James Gebel, MD; Steven Goldstein, MD; Michael Horowitz, MD; Stephen Z. Grahovac, MD; Lawrence R. Wechsler, MD; Maxim D. Hammer, MD; Ken Uchino, MD Tudor G. Jovin, MD

From the Department of Neurology (R.G., J.G., L.R.W., M.D.H., K.U., T.G.J.), Stroke Institute, University of Pittsburgh Medical Center, Pa; the Department of Neurology (R.G.), Section of Stroke and Neurocritical Care, Michigan State University, East Lansing, Mich; the Department of Neurosurgery (H.Y.), University of New Mexico, Albuquerque; the Department of Neurosurgery (M.H., T.G.J.), University of Pittsburgh Medical Center, Pa; and the Department of Radiology (M.H., S.Z.G.), University of Pittsburgh Medical Center, Pa.

Correspondence and reprint requests to Tudor G. Jovin, MD, Department of Neurology, Stroke Institute, University of Pittsburgh Medical Center, 200 Lothrop St, Suite C-400, Stroke Institute, Pittsburgh, PA 15213. E-mail jovintg{at}upmc.edu

Background and Purpose— Intracerebral hemorrhage (ICH) can be a devastating complication associated with thrombolytic therapy for acute ischemic stroke. We hypothesized that patients with lower prethrombolysis cerebral blood flow (CBF) were at a higher risk of symptomatic ICH (sICH).

Methods— Twenty-three patients who underwent quantitative CBF assessment with Xenon CT studies for acute stroke before intra-arterial (IA) thrombolysis for a middle cerebral artery (MCA) or internal carotid artery terminus occlusion within 6 hours of symptom onset were studied. Univariate and multivariate analysis were carried out to determine predictors of sICH post-IA thrombolysis. Receiver operating characteristic curves were generated to determine the association between mean ipsilateral CBF and the occurrence of sICH.

Results— The mean age of our cohort was 68±12 years and a mean National Institutes of Health Stroke Scale (NIHSS) score of 18±3. In univariate analysis, patients with higher percent of core infarct, hyperglycemia, and reduced mean ipsilateral CBF were at risk of sICH. In multivariate analysis only mean ipsilateral CBF was associated with higher rates of sICH (odds ratio 1.58; 95% CI, 1.01 to 2.51; P<0.04). The area under the receiver operating characteristic curve was 0.87 (95% CI, 0.76 to 0.97; P<0.005).

Conclusions— Patients with lower pre-IA thrombolysis mean ipsilateral MCA CBF are at significantly higher risk for sICH in the setting of a MCA or carotid terminus occlusion. The threshold identified in this study may be useful for selection of patients with acute MCA occlusions for acute stroke thrombolysis.

Key Words: acute stroke • intracranial hemorrhage • thrombolysis

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