Abstract T MP13: Chagas Disease Related Stroke: Safety of Intravenous Thrombolysis and Endovascular Treatment
Background: AND AIM: Chagas disease (CD) is a common cause of stroke in undeveloped countries and has become more frequent in the US, where it is largely underestimated. CD related strokes are believed to be mainly cardioembolic but some studies have suggested concomitant cerebral vasculitis. Data on the safety of recanalization therapies in patients with acute stroke related to CD is still restricted to single case reports. We aimed to assess the rate of symptomatic intracranial hemorrhage (SIH) in a group of patients with CD-related stroke treated with intravenous tissue plasminogen activator (IV TPA) and/or endovascular therapy.
METHODS: We performed a retrospective analysis of a prospective, single-center, hospital-based registry of acute stroke patients treated with IV TPA and/or endovascular therapy and routinely tested for CD. Demographics, medical history and clinical data were obtained from the registry. CT scans at admission and after 24-48 hours were blindly reviewed by two experienced stroke neurologists, who rated the presence of hemorrhage transformation according to the European Cooperative Acute Stroke Study criteria.
RESULTS: From 2001 to 2012, 197 patients met the inclusion criteria for this study. CD was diagnosed in 30 patients (15.2%). Patients with CD had higher admission scores on the National Institute of Health Stroke Scale [median: 19; interquartile range (IR): 16-22; no CD: 14; IR: 9-19; P<0.01]. Among patients treated with IV TPA, the rate of SIH was similar among patients with CD (1/24; 4.2%) and patients without CD (8/150; 5.3%; OR: 0.77, 95% CI: 0.09-6.46; P=0.99). Among those treated with rescue endovascular treatment, SIH occurred in 2/6 (33.3%) patients with CD and in 3/17 (17.6%) patients without CD (OR: 2.33, 95%CI: 0.28-19.17, P=0.58). Overall, there was no difference in mortality between groups [CD: 6 (20%); no CD: 24 (14.4%); OR: 1.49; 95% CI: 0.55-4.0; P=0.42].
CONCLUSIONS: In the largest series of patients with acute stroke related to CD treated with recanalization therapies ever reported, we found that IV TPA appears to be safe in these patients. Further studies are necessary to confirm the safety and efficacy of endovascular recanalization strategies in patients with CD.
Author Disclosures: P.T. Cougo-Pinto: None. B.L. Dos Santos: None. F.A. Dias: None. M.R. Camilo: Research Grant; Significant; The State of São Paulo Research Foundation (FAPESP). F.F. Alessio-Alves: None. C.M.A. Barreira: None. T.E.G. Santos-Pontelli: Research Grant; Significant; Coordination for the Improvement of Higher Education Personnel (CAPES). D.G. Abud: None. J.P. Leite: Research Grant; Significant; The National Council for Scientific and Technological Development (CNPQ), The State of São Paulo Research Foundation (FAPESP), Coordination for the Improvement of Higher Education Personnel (CAPES). O.M. Pontes-Neto: Research Grant; Significant; The National Council for Scientific and Technological Development (CNPQ-237616/20122), The State of São Paulo Research Foundation (FAPESP).
- © 2014 by American Heart Association, Inc.