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. 2011 Jul;1(3):138-47.
doi: 10.1177/1941875211408731.

Safety of thrombolysis in acute ischemic stroke: a review of complications, risk factors, and newer technologies

Daniel J Miller  1 , Jennifer R Simpson, Brian Silver
Affiliations

Safety of thrombolysis in acute ischemic stroke: a review of complications, risk factors, and newer technologies

Daniel J Miller et al. Neurohospitalist. 2011 Jul.

Abstract

Intravenous recombinant tissue plasminogen activator (r-tPA) was approved for use in acute ischemic stroke in the United States in 1996. Approximately 2% to 5% of patients with acute ischemic stroke receive r-tPA. Complications related to intravenous r-tPA include symptomatic intracranial hemorrhage, major systemic hemorrhage, and angioedema in approximately 6%, 2%, and 5% of patients, respectively. Risk factors for symptomatic hemorrhage include age, male gender, obesity, increased stroke severity, diabetes, hyperglycemia, uncontrolled hypertension, combination antiplatelet use, large areas of early ischemic change, atrial fibrillation, congestive heart failure, and leukoariosis. A risk factor for angioedema is the use of angiotensin-converting enzyme inhibitor. Risk assessment scores, novel imaging strategies, and telemedicine may offer methods of optimizing the risk-benefit ratio.

Keywords: safety; stroke; thrombolysis.

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Conflict of interest statement

The author(s) declared a potential conflict of interest (e.g. a financial relationship with the commercial organizations or products discussed in this article) as follows: Drs Miller and Simpson have nothing to report. Dr Silver has received consulting fees from Abbott Vascular and has served as an expert for stroke medical malpractice defense.

Figures

Figure 1.
Figure 1.
Hemorrhage on head CT following intra-arterial thrombolysis. CT indicates computed tomography.
Figure 2.
Figure 2.
ASPECTS system. ASPECTS is a semiquantitative method where 1 point is assigned for each normal area (maximum score of 10). The areas scored are depicted on the left-hand side of the scans and the caudate nucleus (C). The anterior circulation and posterior circulation, depicted on the right-hand side of the scan are not scored. The total score for this scan is 3 (1 point each for caudate, M4, and M5). A indicates anterior circulation; P, posterior circulation; C, caudate head; L, lentiform nucleus; I, insular ribbon; M1, anterior MCA cortex; M2, MCA cortex lateral to insular ribbon; M3, posterior cortex; M4, anterior MCA territory 2 cm superior to M1; M5, lateral MCA territory 2 cm superior to M2; M6, posterior MCA territory 2 cm superior to M3. ASPECTS indicates the Alberta Stroke Programme Early CT Score; CT, computed tomography; MCA, middle cerebral artery.
See this image and copyright information in PMC

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