Orolingual angioedema after alteplase therapy of acute ischaemic stroke: incidence and risk of prior angiotensin‐converting enzyme inhibitor use

Abstract

The incidence of rt-PA-related OA in the Asian population is lower than that in the Caucasian population. Pre-stroke use of ACE inhibitors significantly increases the risk of this complication.

Orolingual angioedema after thrombolysis is not associated with insular cortex ischemia on pre-thrombolysis CT

“…Prevalence of OA in patients with acute ischemic stroke treated with alteplase was 4.9%, which is in accordance to previous studies [1][2][3][4]7]. We found no significant differences in the frequency of insular cortex ischemic lesions on pre-thrombolysis CT, and early signs of insular cortex ischemia were not independent predictors of OA occurrence in multivariate analysis.…”

“…Other case control-studies found a higher frequency of OA in women [3,5] and, in our study, female sex was an independent risk factor for OA, which is in accordance to a large cohort study of medication-related angioedema incidence [9]. The reason for this sex difference is not clear, but may include the influence of sex hormones on the regulation of inflammation and an increased T h 2 immune response in women [10], which is further supported by the female predominance of chronic urticaria, a condition with a pathophysiology closely linked to acquired angioedema [11].…”

“…In addition to contribute to several high order complex cerebral functions, insular cortex is known to mediate autonomic responses and it is involved in cardiac and vascular autonomic tone regulation and visceromotor control. The imbalance of sympathetic and parasympathetic control induced by insular ischemic lesions was proposed by several authors to contribute to the pathophysiology of OA [2][3][4][5]. Our aim was to study risk factors for OA occurrence in ischemic stroke patients treated with alteplase, in particular association with insular ischemia.…”

“…Orolingual angioedema (OA) is a well known early complication of alteplase when used for treatment of acute ischemic stroke, occurring in up to 7.9% of patients [1][2][3]. It consists of painless swelling of lips, tongue, face and occasionally oropharynx, occurring shortly after intravenous alteplase administration, which usually resolves during the first 24 h. Most case-control studies recognize use of angiotensin-converting enzyme inhibitors (ACE-I) as the main risk factor for occurrence of this potentially serious adverse event [1][2][3][4], and other authors found a higher frequency of insular ischemia in patients who developed angioedema [2,5].…”

“…It consists of painless swelling of lips, tongue, face and occasionally oropharynx, occurring shortly after intravenous alteplase administration, which usually resolves during the first 24 h. Most case-control studies recognize use of angiotensin-converting enzyme inhibitors (ACE-I) as the main risk factor for occurrence of this potentially serious adverse event [1][2][3][4], and other authors found a higher frequency of insular ischemia in patients who developed angioedema [2,5]. In addition to contribute to several high order complex cerebral functions, insular cortex is known to mediate autonomic responses and it is involved in cardiac and vascular autonomic tone regulation and visceromotor control.…”