Published Online
on September 7, 2006

A more recent version of this article appeared on October 1, 2006

This Article Full Text (PDF) All Versions of this Article: 37/10/2526    most recent 01.STR.0000240687.14265.b4v1 Alert me when this article is cited Alert me if a correction is posted 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 Gupta, R. Articles by Jovin, T. G. Search for Related Content PubMed PubMed Citation Articles by Gupta, R. Articles by Jovin, T. G. Related Collections Acute Cerebral Hemorrhage Emergency treatment of Stroke Other imaging Thrombolysis

Submitted on March 28, 2006
Revised on June 14, 2006
Accepted on July 4, 2006

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; and 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.

^* To whom correspondence should be addressed. 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

This article has been cited by other articles:

				S. Sugiura, K. Iwaisako, S. Toyota, and H. Takimoto Simultaneous Treatment with Intravenous Recombinant Tissue Plasminogen Activator and Endovascular Therapy for Acute Ischemic Stroke Within 3 Hours of Onset AJNR Am. J. Neuroradiol., June 1, 2008; 29(6): 1061 - 1066. [Abstract] [Full Text] [PDF]

				S. Schulman, R. J. Beyth, C. Kearon, and M. N. Levine Hemorrhagic Complications of Anticoagulant and Thrombolytic Treatment: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 257S - 298S. [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]