Observational Study

. 2016 Aug;47(8):2003-9.

doi: 10.1161/STROKEAHA.116.013952. Epub 2016 Jul 12.

Remote Intracerebral Hemorrhage After Intravenous Thrombolysis: Results From a Multicenter Study

Luis Prats-Sánchez¹, Pol Camps-Renom², Javier Sotoca-Fernández², Raquel Delgado-Mederos², Alejandro Martínez-Domeño², Rebeca Marín², Miriam Almendrote², Laura Dorado², Meritxell Gomis², Javier Codas², Laura Llull², Alejandra Gómez González², Jaume Roquer², Francisco Purroy², Manuel Gómez-Choco², David Cánovas², Dolores Cocho², Moises Garces², Sonia Abilleira², Joan Martí-Fàbregas²; Catalan Stroke Code and Reperfusion Consortium (Cat-SCR)

Affiliations

¹ From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G.-C.); Hospital Universitari de Sabadell-Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Hospital General Universitari de Granollers, Granollers, Spain (D.C.); Hospital Verge de la Cinta, Tortosa, Spain (M.G.); and Stroke Programme/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A.). lpratss@santpau.cat.
² From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G.-C.); Hospital Universitari de Sabadell-Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Hospital General Universitari de Granollers, Granollers, Spain (D.C.); Hospital Verge de la Cinta, Tortosa, Spain (M.G.); and Stroke Programme/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A.).

PMID: 27406103
DOI: 10.1161/STROKEAHA.116.013952

Observational Study

Remote Intracerebral Hemorrhage After Intravenous Thrombolysis: Results From a Multicenter Study

Luis Prats-Sánchez et al. Stroke. 2016 Aug.

. 2016 Aug;47(8):2003-9.

doi: 10.1161/STROKEAHA.116.013952. Epub 2016 Jul 12.

Authors

Affiliations

¹ From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G.-C.); Hospital Universitari de Sabadell-Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Hospital General Universitari de Granollers, Granollers, Spain (D.C.); Hospital Verge de la Cinta, Tortosa, Spain (M.G.); and Stroke Programme/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A.). lpratss@santpau.cat.
² From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G.-C.); Hospital Universitari de Sabadell-Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Hospital General Universitari de Granollers, Granollers, Spain (D.C.); Hospital Verge de la Cinta, Tortosa, Spain (M.G.); and Stroke Programme/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A.).

PMID: 27406103
DOI: 10.1161/STROKEAHA.116.013952

Erratum in

Correction to: Remote Intracerebral Hemorrhage After Intravenous Thrombolysis: Results From a Multicenter Study.
[No authors listed] [No authors listed] Stroke. 2017 Oct;48(10):e320. doi: 10.1161/STR.0000000000000151. Stroke. 2017. PMID: 28947601 No abstract available.

Abstract

Background and purpose: Remote parenchymal hemorrhage (rPH) after intravenous thrombolysis with recombinant tissue-type plasminogen activator may be associated with cerebral amyloid angiopathy, although supportive data are limited. We aimed to investigate risk factors of rPH after intravenous thrombolysis with recombinant tissue-type plasminogen activator.

Methods: This is an observational study of patients with ischemic stroke who were treated with intravenous thrombolysis with recombinant tissue-type plasminogen activator and were included in a multicenter prospective registry. rPH was defined as any extraischemic hemorrhage detected in the follow-up computed tomography. We collected demographic, clinical, laboratory, radiological, and outcome variables. In the subset of patients who underwent a magnetic resonance imaging examination, we evaluated the distribution and burden of cerebral microbleeds, cortical superficial siderosis, leukoaraiosis, and recent silent ischemia in regions anatomically unrelated to the ischemic lesion that caused the initial symptoms. We compared patients with rPH with those without rPH or parenchymal hemorrhage. Independent risk factors for rPH were obtained by multivariable logistic regression analyses.

Results: We evaluated 992 patients (mean age, 74.0±12.6 years; 52.9% were men), and 408 (41%) of them underwent a magnetic resonance imaging. Twenty-six patients (2.6%) had a rPH, 8 (0.8%) had both rPH and PH, 58 (5.8%) had PH, and 900 (90.7%) had no bleeding complication. Lobar cerebral microbleeds (odds ratio, 8.0; 95% confidence interval, 2.3-27.2) and recent silent ischemia (odds ratio, 4.8; 95% confidence interval, 1.6-14.1) increased the risk of rPH.

Conclusions: The occurrence of rPH after intravenous thrombolysis with recombinant tissue-type plasminogen activator in patients with ischemic stroke is associated with lobar cerebral microbleeds and multiple ischemic lesions in different regions.

Keywords: amyloid; cerebral amyloid angiopathy; cerebral hemorrhage; stroke; thrombolytic therapy.

PubMed Disclaimer

Cited by

Early administration of pyrrolidine dithiocarbamate extends the therapeutic time window of tissue plasminogen activator in a male rat model of embolic stroke.
Wang Z, Shan W, Cao J, Wintermark M, Huang W, Zuo Z. Wang Z, et al. J Neurosci Res. 2018 Mar;96(3):449-458. doi: 10.1002/jnr.24186. Epub 2017 Oct 4. J Neurosci Res. 2018. PMID: 28976017 Free PMC article.
Exploring the Impact of Cerebral Microbleeds on Stroke Management.
Sousanidou A, Tsiptsios D, Christidi F, Karatzetzou S, Kokkotis C, Gkantzios A, Bairaktaris C, Karapepera V, Bebeletsi P, Karagiannakidou I, Marinidis M, Aggelousis N, Vadikolias K. Sousanidou A, et al. Neurol Int. 2023 Feb 1;15(1):188-224. doi: 10.3390/neurolint15010014. Neurol Int. 2023. PMID: 36810469 Free PMC article. Review.
Suitability of Thrombolysis for Patients With Acute Ischemic Stroke Complicated With Trousseau Syndrome.
Chen Y, Zhang C, Wang X, Han L, Zhu S, Liu Y, Wang R, Geng Z, Ma C, Dong R. Chen Y, et al. Front Neurosci. 2020 Jun 12;14:481. doi: 10.3389/fnins.2020.00481. eCollection 2020. Front Neurosci. 2020. PMID: 32595439 Free PMC article.
The Risk of Symptomatic Intracranial Hemorrhage after Thrombolysis for Acute Stroke: Current Concepts and Perspectives.
Modrego PJ. Modrego PJ. Ann Indian Acad Neurol. 2019 Jul-Sep;22(3):336-340. doi: 10.4103/aian.AIAN_323_18. Ann Indian Acad Neurol. 2019. PMID: 31359953 Free PMC article.
Risk factors are different for deep and lobar remote hemorrhages after intravenous thrombolysis.
Prats-Sanchez L, Martínez-Domeño A, Camps-Renom P, Delgado-Mederos R, Guisado-Alonso D, Marín R, Dorado L, Rudilosso S, Gómez-González A, Purroy F, Gómez-Choco M, Cánovas D, Cocho D, Garces M, Abilleira S, Martí-Fàbregas J. Prats-Sanchez L, et al. PLoS One. 2017 Jun 22;12(6):e0178284. doi: 10.1371/journal.pone.0178284. eCollection 2017. PLoS One. 2017. PMID: 28640874 Free PMC article.

See all "Cited by" articles

Publication types

Actions
Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Substances

Actions
Actions

LinkOut - more resources

Full Text Sources
Other Literature Sources
- scite Smart Citations
Medical
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Remote Intracerebral Hemorrhage After Intravenous Thrombolysis: Results From a Multicenter Study

Affiliations

Remote Intracerebral Hemorrhage After Intravenous Thrombolysis: Results From a Multicenter Study

Authors

Affiliations

Erratum in

Abstract

Similar articles

Cited by

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Erratum in

Abstract

Similar articles

Cited by

Publication types

MeSH terms

Substances

Related information

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical