Abstract 178: Persistent Occlusion After Intravenous Thrombolysis Is Not Associated with Symptomatic Intracerebral Hemorrhage.
Introduction: There is no conclusive evidence if the association between status of brain artery and risk of intracerebral hemorhage after intravenous thrombolysis (IVT) exists. Therefore, we explored if the hyperdense cerebral artery sign (HCAS) on CT or CT-angiography (CTA)-evidenced occlusion at baseline and follow-up after intravenous thrombolysis (IVT) is associated with symptomatic intracerebral hemorrhage (SICH).
Methods: The study population was the Safe Implementation of Treatments in Stroke-EAST (SITS-EAST) database with all stroke patients between February 2003 and December 2011 receiving IVT up to 4.5 hours after symptom onset. SICH was distinguished as per NINDS, ECASS II and SITS-MOST definitions. Arterial patency at baseline and on follow-up was assessed by the presence of HCAS on CT or by CTA. Logistic regression was used to adjust for differences in the following baseline variables: NIHSS baseline, age, sex, onset to treatment time, weight, early ischemic changes on CT, systolic blood pressure, glucose, actilyse dose, treatment with anticoagulation or antiplatelets, stroke subtype by ICD classification, history of hypertension, diabetes mellitus, atrial fibrillation, congestive heart failure, and previous stroke.
Results: Of 8878 cases, baseline CT scans revealed HCAS in 1553 (19%) of 8375 patients and CTA-evidenced occlusion in 1606 (57%) of 2809 cases. On follow-up CT after IVT, HCAS persisted in 477 (36%) of 1327 cases and CTA-evidenced occlusion persisted in 185 (45%) of 411 cases. After adjustment, SICH per the NINDS definition was independently predicted at baseline both by the presence of HCAS (OR 1.57, 95%CI 1.20 to 2.05) and occlusion on CTA (OR 2.87, 95%CI 1.69 to 4.87). Also SICH per the ECASS II definition was independently predicted by the presence of occlusion on CTA (OR 2.61, 95%CI 1.34 to 5.05). In contrast, at follow-up neither persistent HCAS nor persistent CTA-evidenced occlusion was associated with SICH per any definition.
Conclusions: In stroke patients receiving IVT, presence of clot at admission was an independent predictor of SICH. Persistent occlusion after IVT was not, however, associated with SICH.
- © 2012 by American Heart Association, Inc.