Symptomatic intracranial hemorrhage after stroke thrombolysis: The SEDAN Score

Strbian, Daniel; Engelter, Stefan T.; Michel, Patrik; Meretoja, Atte; Šekoranja, Lučka; Ahlhelm, F.; Mustanoja, Satu; Kuzmanovic, I; Sairanen, Tiina; Forss, Nina; Cordier, M; Lyrer, Philippe; Kaste, Markku; Tatlısumak, Turgut

doi:10.1002/ana.23546

Cited by 248 publications

(242 citation statements)

References 19 publications

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“…[140][141][142] Clinical Factors: Age, Hypertension, Hyperglycemia, and Hemorrhagic Transformation Increasing age has frequently been associated with an increased risk of HT in patients with stroke. 8,26,50,[143][144][145][146][147][148] The mechanisms by which age may contribute to HT are unclear. Age may enhance the production of ROS which promotes BBB disruption.…”

Section: Clinical Factors Associated With Hemorrhagic Transformationmentioning

confidence: 99%

“…151 Hypertension is also associated with an increased risk of HT in stroke patients. 8,[144][145][146]152,153 Acute elevations in blood pressure are presumed to directly affect BBB permeability and increase HT.…”

Section: Clinical Factors Associated With Hemorrhagic Transformationmentioning

confidence: 99%

“…Clinical scores to predict HT that have been developed include the Multicenter Stroke Survey, 143 the Hemorrhage After Thrombolysis score, 170 and the Safe Implementation of Thrombolysis in Stroke Symptomatic Intracerebral Hemorrhage score, 144 the blood Sugar, Early infarct signs and hyperDense cerebral artery sign, Age, and NIHSS score, 145 the Glucose Race Age Sex Pressure Stroke Severity score, 146 the Stroke Prognostication using Age and NIHSS-100 index, 147 and the iScore 148 (Table 1). Though each score is able to identify patients at increased risk of HT, they do not achieve sufficient sensitivity or specificity to withhold tPA in otherwise tPA eligible patients.…”

Section: Clinical Factors Associated With Hemorrhagic Transformationmentioning

confidence: 99%

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Hemorrhagic Transformation after Ischemic Stroke in Animals and Humans

Jickling

Liu

Stamova

et al. 2013

J Cereb Blood Flow Metab

461

369

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Hemorrhagic transformation (HT) is a common complication of ischemic stroke that is exacerbated by thrombolytic therapy. Methods to better prevent, predict, and treat HT are needed. In this review, we summarize studies of HT in both animals and humans. We propose that early HT (o18 to 24 hours after stroke onset) relates to leukocyte-derived matrix metalloproteinase-9 (MMP-9) and brain-derived MMP-2 that damage the neurovascular unit and promote blood-brain barrier (BBB) disruption. This contrasts to delayed HT (418 to 24 hours after stroke) that relates to ischemia activation of brain proteases (MMP-2, MMP-3, MMP-9, and endogenous tissue plasminogen activator), neuroinflammation, and factors that promote vascular remodeling (vascular endothelial growth factor and high-moblity-group-box-1). Processes that mediate BBB repair and reduce HT risk are discussed, including transforming growth factor beta signaling in monocytes, Src kinase signaling, MMP inhibitors, and inhibitors of reactive oxygen species. Finally, clinical features associated with HT in patients with stroke are reviewed, including approaches to predict HT by clinical factors, brain imaging, and blood biomarkers. Though remarkable advances in our understanding of HT have been made, additional efforts are needed to translate these discoveries to the clinic and reduce the impact of HT on patients with ischemic stroke.

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Section: Clinical Factors Associated With Hemorrhagic Transformationmentioning

confidence: 99%

Section: Clinical Factors Associated With Hemorrhagic Transformationmentioning

confidence: 99%

Section: Clinical Factors Associated With Hemorrhagic Transformationmentioning

confidence: 99%

See 1 more Smart Citation

Hemorrhagic Transformation after Ischemic Stroke in Animals and Humans

Jickling

Liu

Stamova

et al. 2013

J Cereb Blood Flow Metab

461

369

View full text Add to dashboard Cite

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“…The lower the ASPECTS score the bigger the infarcted area, thus bigger the risk of HT. ASPECT score is an independent predictor of HT with the sensitivity of 85,5% and with the specificity of 75% [69, 129,130].…”

Section: Neuroimagingmentioning

confidence: 99%

“…Dense cerebral artery sign: Hyperdense cerebral artery sign is independently predictive for HT after thrombolytic therapy [130,131].…”

Section: Neuroimagingmentioning

confidence: 99%

Hemorrhagic transformation of ischemic stroke

J¹,

Hortobágyi²

2017

Vascul Dis Ther

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The better understanding of the diverse mechanisms leading to the hemorrhagic transformation of an ischemic stroke is the crucial point in the prevention of this altogether common phenomenon. The different individual risk factors include the anatomical variability of collateral blood supply, age, genetics, body weight, etiology of the occlusion, side of the occluded vessel, renal status, stroke severity, history of high serum glucose or hypertension and hypertension or hyperglycemia at the onset of the stroke, ferritin level, INR, antiplatelet usage or the platelet count etc. All these might contribute to the process of hemorrhagic transformation. These risk factors have been identified by retrospective epidemiological studies and are useful to identify patients who are at high risk for hemorrhagic conversion and help the decision between conservative, thrombolytic or more advanced treatments such as thrombectomy. The modulations of potential molecular targets participating in the process seem to be promising in animal models, but human trials are lacking the breakthrough success so far, both in extending the time frame of the thrombolysis and in replacing the recombinant tissue plasminogen activator (rtPA) as thrombolytic agent.So far, the careful preselection of patients eligible for thrombolytic therapy is the best way to prevent hemorrhagic transformation. The intensive research in the field revealing small but important molecular details are continuously contributing to the better understanding of hemorrhagic transformation with the intention of finding new agents that co-administrated to the rtPA or completely replacing that could decrease the risk of secondary bleeding.The aim of this review is to give comprehensive insight into the process of hemorrhagic transformation of ischemic stroke, starting with basic overview of the penumbra concept and the collateral supply followed by discussion of the recanalisation-reperfusion-hemorrhagic transformation process after vessel occlusion also highlighting the importance of timing and ratio of recanalisation spontaneously and in case of thrombolytic agent administration. We overview the risk factors of hemorrhagic transformation, which may be helpful to physicians to identify high risk patients before rtPA administration. The last part of the work is dealing with future therapeutic possibilities based on the so far revealed molecular mechanisms of hemorrhagic transformation. With the aim to assess the rate and influencing factors on the recanalisation and reperfusion rate 381 patients with large-vessel occlusion was investigated. The patient group involved ones treated with rtPA or treated conservatively. Partial or complete recanalisation was achieved in 121 out of 210 (58%) patients after intravenous rtPA administration. The recanalisation success was more likely if the patient had atrial fibrillation [4] -maybe because cardioembolic clots consists more fibrin and are more likely to reopen by plasmin proteolysis than thrombosis of an atherosclerotic plaq...

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