Remote or Extraischemic Intracerebral Hemorrhage—An Uncommon Complication of Stroke Thrombolysis

Abstract

Differences between risk factor profiles indicate an influence of previous vascular pathology in PHr and acute large-vessel occlusion in PH. Additional research is needed on the effect of pre-existing cerebrovascular disease on complications of recanalization therapy in acute ischemic stroke.

Microbleeds, Cerebral Hemorrhage, and Functional Outcome After Stroke Thrombolysis

“…In a recent meta-analysis, pre-treatment CMBs increased the odds of sICH (pooled odds ratio [OR]: 2.87; 95% confidence interval [CI]: 1.76-4.69; P<0.0001) 7 but could not investigate CMB burden, distribution, or key confounders. 7 We performed a large-scale pooled individual patient data meta-analysis of quality observational studies to test the following hypotheses: (1) there is a relationship between increasing CMB burden and ICH risk 8,9 ; (2) strictly lobar CMBs (reflecting possible or probable cerebral amyloid angiopathy [CAA]) and mixed or strictly deep CMBs (likely associated with hypertensive arteriopathy) have different effects on ICH risk; (3) CMBs are associated more strongly with the risk of remote ICH than other ICH types 10 ; and (4) CMBs are associated with worse functional outcome.…”

Management of Postthrombolysis Hemorrhagic and Orolingual Angioedema Complications

“…Remote postthrombolysis cerebral hemorrhages can be solitary or multiple and by definition appear in brain regions without visible ischemic damage. 39 Traditionally, the risk of remote cerebral hemorrhage postthrombolysis has been reported as occurring in approximately 1.3% to 3.7% of patients. 24,27,39,40 However, the recent Safe Implementation of Treatment in Stroke-International Stroke Thrombolysis Register (SITS-ISTR) study, which included 45 079 patients treated with IV r-tPA, discovered that remote parenchymal hematomas made up one-third of all parenchymal hematomas after IV thrombolysis.…”

“…39 Traditionally, the risk of remote cerebral hemorrhage postthrombolysis has been reported as occurring in approximately 1.3% to 3.7% of patients. 24,27,39,40 However, the recent Safe Implementation of Treatment in Stroke-International Stroke Thrombolysis Register (SITS-ISTR) study, which included 45 079 patients treated with IV r-tPA, discovered that remote parenchymal hematomas made up one-third of all parenchymal hematomas after IV thrombolysis. 39 Patients with remote hematomas postthrombolysis were more likely to be female, with a higher median age, and have a history of previous nonrecent stroke (>3 months) compared to patients with local/intraischemic parenchymal hemorrhage.…”

“…24,27,39,40 However, the recent Safe Implementation of Treatment in Stroke-International Stroke Thrombolysis Register (SITS-ISTR) study, which included 45 079 patients treated with IV r-tPA, discovered that remote parenchymal hematomas made up one-third of all parenchymal hematomas after IV thrombolysis. 39 Patients with remote hematomas postthrombolysis were more likely to be female, with a higher median age, and have a history of previous nonrecent stroke (>3 months) compared to patients with local/intraischemic parenchymal hemorrhage. They were also less likely to have severe strokes, early infarct signs, and hyperdense cerebral artery signs (HCAS) on baseline CT head, which were all characteristics more commonly found in patients with local/ intraischemic hemorrhage.…”

“…We must consider the possibility of underlying cerebral amyloid angiopathy (CAA) as another mechanism of remote hemorrhage in postthrombolysis patients, as these patients were more often female and older in SITS-ISTR, similar to postmortem studies of spontaneous CAA-related ICH in which patients with CAA were also more likely older and female. 39,41,42 Randomized clinical trials have shown that r-tPA dosed at 0.9 mg/kg with a maximum dose of 90 mg is not only safe but also effective. 1 There are some who propose the use of lower doses of r-tPA in populations at higher risk of ICH, such as East Asian populations, as a way to decrease the risk of bleeding.…”