Is it dangerous to treat acute ischemic stroke by thrombolytic therapy in patients with comorbid intracranial aneurysms?

Abstract

Objectives: The safety of cerebral ischemic stroke patients with comorbid intracranial aneurysms treated by thrombolysis is still an unsolved mystery. We aimed to perform a secondary analysis and review to provide evidence on whether stroke patients with intracranial aneurysms have worse outcomes after thrombolysis.

Methods: We searched almost all the relevant English articles published before June 21, 2015, using databases such as Medline, Embase, and Cochrane and tracked the acquired references to include the available articles. Data were processed using RevMan5.0 software provided by Cochrane collaboration, and relevant clinical guidelines, theory, retrospective studies, and case reports were summarized.

Results: We included 5 retrospective studies totaling 767 patients who met the inclusion and analytical criteria, which included 78 people with intracranial aneurysms. The total relative risk for patients with unruptured intracranial aneurysms developing intracranial hemorrhage after thrombolysis was 0.98 (95% confidence interval [CI], 0.60-1.58; P=.92; I(2)=22%). The total relative risk for symptomatic intracranial hemorrhage was 0.97 (95% CI, 0.37-2.57; P=.95; I(2)=40%). The total relative risk for mortality during hospitalization was 1.09 (95% CI, 0.36-3.31; P=.21; I(2)=36%). We collected 13 case reports for reference.

Conclusion: The presence of unruptured intracranial aneurysms was not associated with a statistically significant increased risk of intracranial hemorrhage, symptomatic intracranial hemorrhage, and inhospital death after intravenous thrombolysis, although some theories and guidelines had opposite views. We suggest to perform more clinical trials with larger samples, multiple centers, and higher level of evidence to draw more reliable conclusions.