Abstract T P19: Higher HDL Levels Increase the Risk of Intracranial Hemorrhage After Endovascular Treatment for Ischemic Stroke
Background and Objectives: Recent evidence has highlighted an inverse relationship between lipids (HDL/LDL) and ischemic versus hemorrhagic stroke. Select patients presenting with ischemic stroke within the 4.5-hour time window should receive IV tPA, and depending on symptom severity or neuroimaging, they may be treated with intra-arterial (IA) tPA or endovascular therapy. Evidence has shown elevated LDL to be a risk factor for ischemic stroke, but once a patient has an ischemic stroke elevated HDL levels may put them at risk for hemorrhagic stroke. Our objective was to determine if serum lipids had a role in increasing the risk of large intracranial hemorrhage after treatment with IV tPA and IA therapy.
Methods: Patients receiving IV tPA for ischemic stroke at a major university affiliated comprehensive stroke center were evaluated from 2011-2013. The procedure notes of patients who underwent IA after IV tPA were reviewed for complications. SPSS software version 22 was used to determine Spearman’s rho correlations between serum lipids and likelihood of complications as well as other baseline parameters, and descriptive statistics with standard deviations to determine the population characteristics.
Results: A total of 1,565 patients with ischemic stroke were evaluated, and 188 (mean age 74.3, 55% men) patients received IV tPA, 68 also underwent intra-arterial (IA) treatment with either IA tPA or thrombectomy and met study criteria. There were 31 males and 37 females with a mean age of 73.4 (SD=14.8). The mean NIHSS was 15.9 at admission and 7.7 at discharge (SD= 6.4 and 5.5, respectively). There were 6 instances of large intracranial hemorrhages (3 symptomatic). Patients with large ICH were significantly more likely to have higher levels of total cholesterol, HDL and LDL (r=.373, r=.323 and r=347, respectively; p<.01).
Conclusion: As expected, patients with elevated LDL were more likely to have severe strokes requiring endovascular treatment. However, Our data suggests that ischemic stroke patients with elevated HDL are not protected and are at increased risk of hemorrhage after intra-arterial therapy. Larger, prospective trials need to be conducted for more definite conclusions.
Author Disclosures: M. Moussavi: None. D. Korya: None. S. Sajjan: None. I. Isaac: None. N. Uhegwu: None. J. Ahmad: None. S. Mehta: None. B. Galea: None. S. Chaudhry: None. J.F. Kirmani: None.
- © 2015 by American Heart Association, Inc.