TY - JOUR
T1 - Cerebral Microbleeds are an Independent Predictor of Hemorrhagic Transformation Following Intravenous Alteplase Administration in Acute Ischemic Stroke
AU - Nagaraja, Nandakumar
AU - Tasneem, Nudrat
AU - Shaban, Amir
AU - Dandapat, Sudeepta
AU - Ahmed, Uzair
AU - Policeni, Bruno
AU - Olalde, Heena
AU - Shim, Hyungsub
AU - Samaniego, Edgar A.
AU - Pieper, Connie
AU - Ortega-Gutierrez, Santiago
AU - Leira, Enrique C.
AU - Adams, Harold P.
N1 - Funding Information:
Conflict of interest: Nandakumar Nagaraja: Consultant as stroke adjudicator for Women's Health Initiative Extension Study. Nudrat Tasneem: No disclosures. Amir Shaban: No disclosures. Sudeepta Dandapat: No disclosures. Uzar Ahmed: No disclosures. Bruno Policeni: No disclosures. Heena Olalde: No disclosures. Hyungsub Shim: No disclosures. Edgar Samaniego: Consultant for Microvention. Connie Pieper: No disclosures. Santiago Ortega-Gutierrez: Consultant for Stryker. Enrique C Leira: Receives salary support from the NINDS. Harold P Adams: Receives funding from NIH for his role as Co-PI of the University of Iowa RCC.
Publisher Copyright:
© 2018 National Stroke Association
PY - 2018/5
Y1 - 2018/5
N2 - Background and Purpose: Intravenous alteplase (rt-PA) increases the risk of hemorrhagic transformation of acute ischemic stroke. The objective of our study was to evaluate clinical, laboratory, and imaging predictors on forecasting the risk of hemorrhagic transformation following treatment with rt-PA. We also evaluated the factors associated with cerebral microbleeds that increase the risk of hemorrhagic transformation. Methods: Consecutive patients with acute ischemic stroke admitted between January 1, 2009 and December 31, 2013 were included in the study if they received IV rt-PA, had magnetic resonance imaging (MRI) of the brain on admission, and computed tomography or MRI of the brain at 24 (18-36) hours later to evaluate for the presence of hemorrhagic transformation. The clinical data, lipid levels, platelet count, MRI, and computed tomography images were retrospectively reviewed. Results: The study included 366 patients, with mean age 67 ± 15 years; 46% were women and 88% were white. The median National Institutes of Health Stroke Scale (NIHSS) score was 6 (interquartile range 3-15). Hemorrhagic transformation was observed in 87 (23.8%) patients and cerebral microbleeds were noted in 95 (25.9%). Patients with hemorrhagic transformation tended to be older, nonwhite, have atrial fibrillation, higher baseline NIHSS score, lower cholesterol and triglyceride levels, and cerebral microbleeds and nonlacunar infarcts. Patients with cerebral microbleeds were more likely to be older, have hypertension, hyperlipidemia, previous history of stroke, and prior use of antithrombotics. On multivariate analysis race, NIHSS score, nonlacunar infarct, and presence of cerebral microbleeds were independently associated with hemorrhagic transformation following treatment with rt-PA. Conclusions: Presence of cerebral microbleeds is an independent predictor of hemorrhagic transformation of acute ischemic stroke following treatment with rt-PA.
AB - Background and Purpose: Intravenous alteplase (rt-PA) increases the risk of hemorrhagic transformation of acute ischemic stroke. The objective of our study was to evaluate clinical, laboratory, and imaging predictors on forecasting the risk of hemorrhagic transformation following treatment with rt-PA. We also evaluated the factors associated with cerebral microbleeds that increase the risk of hemorrhagic transformation. Methods: Consecutive patients with acute ischemic stroke admitted between January 1, 2009 and December 31, 2013 were included in the study if they received IV rt-PA, had magnetic resonance imaging (MRI) of the brain on admission, and computed tomography or MRI of the brain at 24 (18-36) hours later to evaluate for the presence of hemorrhagic transformation. The clinical data, lipid levels, platelet count, MRI, and computed tomography images were retrospectively reviewed. Results: The study included 366 patients, with mean age 67 ± 15 years; 46% were women and 88% were white. The median National Institutes of Health Stroke Scale (NIHSS) score was 6 (interquartile range 3-15). Hemorrhagic transformation was observed in 87 (23.8%) patients and cerebral microbleeds were noted in 95 (25.9%). Patients with hemorrhagic transformation tended to be older, nonwhite, have atrial fibrillation, higher baseline NIHSS score, lower cholesterol and triglyceride levels, and cerebral microbleeds and nonlacunar infarcts. Patients with cerebral microbleeds were more likely to be older, have hypertension, hyperlipidemia, previous history of stroke, and prior use of antithrombotics. On multivariate analysis race, NIHSS score, nonlacunar infarct, and presence of cerebral microbleeds were independently associated with hemorrhagic transformation following treatment with rt-PA. Conclusions: Presence of cerebral microbleeds is an independent predictor of hemorrhagic transformation of acute ischemic stroke following treatment with rt-PA.
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U2 - 10.1016/j.jstrokecerebrovasdis.2017.12.044
DO - 10.1016/j.jstrokecerebrovasdis.2017.12.044
M3 - Article
C2 - 29398533
AN - SCOPUS:85041628927
SN - 1052-3057
VL - 27
SP - 1403
EP - 1411
JO - Journal of Stroke and Cerebrovascular Diseases
JF - Journal of Stroke and Cerebrovascular Diseases
IS - 5
ER -