This Article Full Text Full Text (PDF) All Versions of this Article: 37/2/556    most recent 01.STR.0000196942.84707.71v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Trouillas, P. Articles by von Kummer, R. Search for Related Content PubMed PubMed Citation Articles by Trouillas, P. Articles by von Kummer, R. Related Collections Fibrinogen/fibrin Acute Cerebral Infarction Computerized tomography and Magnetic Resonance Imaging Anticoagulants Antiplatelets Thrombolysis Coagulation and fibronolysis

(Stroke. 2006;37:556.)
© 2006 American Heart Association, Inc.

Comments, Opinions, and Reviews

Classification and Pathogenesis of Cerebral Hemorrhages After Thrombolysis in Ischemic Stroke

From the Cerebrovascular Unit, Hôpital Neurologique, Lyon, France (P.T.) and the Department of Neuroradiology, University Hospital, Dresden, Germany (R.vK).

Correspondence to Pr Paul Trouillas, Cerebrovascular Unit, Hôpital Neurologique, 59 Blvd Pinel, 69003 Lyon, France. E-mail paul.trouillas{at}chu-lyon.fr

Background and Purpose— Brain hemorrhage after ischemic stroke is a serious complication of treatment; however, its pathology is poorly understood. A classification based on brain imaging may help to better understand and avoid causal factors.

Methods— Review of the results of controlled randomized trials and the available literature.

Results— Hemorrhagic infarctions have no impact on clinical outcome and are probably not associated with the thrombolytic itself and the type of reperfusion strategy. They are associated with the extent of ischemic damage and most probably to an ischemic vasculopathy. Parenchymal hematomas are often clinically relevant. Their incidence is affected by the thrombolytic itself, the type, and probably the time point of reperfusion strategy. The loss of hemostatic control seems important in their pathogenesis. Extraischemic hematomas (remote from the infarct), unique or multiple, suggest pre-existing brain pathology, especially cerebral amyloid angiopathy.

Conclusions— The radiological description of 3 different types of brain hemorrhage is useful to better understand the specific pathology and the impact on clinical outcome. It may help to avoid clinically relevant brain hemorrhages.

Key Words: cerebral infarction • hemostasis • heparin • intracranial hemorrhage • thrombolysis

This article has been cited by other articles:

				M. W. Parsons, F. Miteff, G. A. Bateman, N. Spratt, A. Loiselle, J. Attia, and C. R. Levi Acute ischemic stroke: Imaging-guided tenecteplase treatment in an extended time window Neurology, March 10, 2009; 72(10): 915 - 921. [Abstract] [Full Text] [PDF]

				L Derex and N Nighoghossian Intracerebral haemorrhage after thrombolysis for acute ischaemic stroke: an update J. Neurol. Neurosurg. Psychiatry, October 1, 2008; 79(10): 1093 - 1099. [Abstract] [Full Text] [PDF]

				M. Paciaroni, G. Agnelli, F. Corea, W. Ageno, A. Alberti, A. Lanari, V. Caso, S. Micheli, L. Bertolani, M. Venti, et al. Early Hemorrhagic Transformation of Brain Infarction: Rate, Predictive Factors, and Influence on Clinical Outcome: Results of a Prospective Multicenter Study Stroke, August 1, 2008; 39(8): 2249 - 2256. [Abstract] [Full Text] [PDF]

				B R Thanvi, S Treadwell, and T Robinson Haemorrhagic transformation in acute ischaemic stroke following thrombolysis therapy: classification, pathogenesis and risk factors Postgrad. Med. J., July 1, 2008; 84(993): 361 - 367. [Abstract] [Full Text] [PDF]

				W. S. Smith, G. Sung, J. Saver, R. Budzik, G. Duckwiler, D. S. Liebeskind, H. L. Lutsep, M. M. Rymer, R. T. Higashida, S. Starkman, et al. Mechanical Thrombectomy for Acute Ischemic Stroke: Final Results of the Multi MERCI Trial Stroke, April 1, 2008; 39(4): 1205 - 1212. [Abstract] [Full Text] [PDF]

				K. Lin, K.S. Kazmi, M. Law, J. Babb, N. Peccerelli, and B.K. Pramanik Measuring Elevated Microvascular Permeability and Predicting Hemorrhagic Transformation in Acute Ischemic Stroke Using First-Pass Dynamic Perfusion CT Imaging AJNR Am. J. Neuroradiol., August 1, 2007; 28(7): 1292 - 1298. [Abstract] [Full Text] [PDF]

				N.A. Vora, R. Gupta, A.J. Thomas, M.B. Horowitz, A.H. Tayal, M.D. Hammer, K. Uchino, L.R. Wechsler, and T.G. Jovin Factors Predicting Hemorrhagic Complications after Multimodal Reperfusion Therapy for Acute Ischemic Stroke AJNR Am. J. Neuroradiol., August 1, 2007; 28(7): 1391 - 1394. [Abstract] [Full Text] [PDF]

				M. G. Lansberg, V. N. Thijs, R. Bammer, S. Kemp, C. A.C. Wijman, M. P. Marks, G. W. Albers, and on behalf of the DEFUSE Investigators Risk Factors of Symptomatic Intracerebral Hemorrhage After tPA Therapy for Acute Stroke Stroke, August 1, 2007; 38(8): 2275 - 2278. [Abstract] [Full Text] [PDF]

				M. Castellanos, T. Sobrino, M. Millan, M. Garcia, J. Arenillas, F. Nombela, D. Brea, N. Perez de la Ossa, J. Serena, J. Vivancos, et al. Serum Cellular Fibronectin and Matrix Metalloproteinase-9 as Screening Biomarkers for the Prediction of Parenchymal Hematoma After Thrombolytic Therapy in Acute Ischemic Stroke: A Multicenter Confirmatory Study Stroke, June 1, 2007; 38(6): 1855 - 1859. [Abstract] [Full Text] [PDF]

				P. Trouillas Lowering the bleeding risk in intra-arterial thrombolysis without losing efficiency by excluding adjunctive heparin? J. Neurol. Neurosurg. Psychiatry, March 1, 2007; 78(3): 222 - 223. [Full Text] [PDF]

				G. Thomalla, J. Sobesky, M. Kohrmann, J. B. Fiebach, J. Fiehler, O. Zaro Weber, A. Kruetzelmann, T. Kucinski, M. Rosenkranz, J. Rother, et al. Two Tales: Hemorrhagic Transformation but Not Parenchymal Hemorrhage After Thrombolysis Is Related to Severity and Duration of Ischemia: MRI Study of Acute Stroke Patients Treated With Intravenous Tissue Plasminogen Activator Within 6 Hours Stroke, February 1, 2007; 38(2): 313 - 318. [Abstract] [Full Text] [PDF]

				P. Khatri, L. R. Wechsler, and J. P. Broderick Intracranial Hemorrhage Associated With Revascularization Therapies Stroke, February 1, 2007; 38(2): 431 - 440. [Abstract] [Full Text] [PDF]

				I. Dzialowski, J. H. W. Pexman, P. A. Barber, A. M. Demchuk, A. M. Buchan, M. D. Hill, and on behalf of the CASES Investigators Asymptomatic Hemorrhage After Thrombolysis May Not Be Benign: Prognosis by Hemorrhage Type in the Canadian Alteplase for Stroke Effectiveness Study Registry Stroke, January 1, 2007; 38(1): 75 - 79. [Abstract] [Full Text] [PDF]

				R. Gupta, H. Yonas, J. Gebel, S. Goldstein, M. Horowitz, S. Z. Grahovac, L. R. Wechsler, M. D. Hammer, K. Uchino, and T. G. Jovin 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 Stroke, October 1, 2006; 37(10): 2526 - 2530. [Abstract] [Full Text] [PDF]