Timing of symptomatic intracerebral hemorrhage after rt-PA treatment in ischemic stroke

Chen, Patrick; Lehmann, B; Meyer, Brett C.; Rapp, Karen; Hemmen, Thomas; Modir, Royya; Agrawal, Kunal; Hailey, Lovella; Mortin, Melissa; Meyer, Dawn M

doi:10.1212/cpj.0000000000000632

Cited by 4 publications

(4 citation statements)

References 10 publications

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“…The timing patterns of sICH after EVT found in this study are for a large part in line with timing patterns of sICH found in the NINDS trial, and also with that of a more recent prospective study on the timing of sICH after intravenous alteplase. 3 , 9 However, we did find a slightly higher risk of sICH after more than 24 h. This could very well be attributed to the different definitions (neurological deterioration ⩾4 points on the NIHSS vs any neurological deterioration) and time windows (3 months vs 36 h) used for sICH. In line with other observational studies, we found that the majority of sICHs occurred within 12 h after stroke treatment.…”

Section: Discussionmentioning

confidence: 74%

“…In line with other observational studies, we found that the majority of sICHs occurred within 12 h after stroke treatment. 2 , 9 , 10 Therefore, more frequent neurological assessments are warranted during these hours. Altogether, it seems justified to extrapolate current protocols on the frequency of neurological assessments after intravenous alteplase treatment to patients treated with EVT.…”

Section: Discussionmentioning

confidence: 99%

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Timing of symptomatic intracranial hemorrhage after endovascular stroke treatment

Steen

Ende

Kranendonk

et al. 2022

European Stroke Journal

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Introduction: Little is known about the timing of occurrence of symptomatic intracranial hemorrhage (sICH) after endovascular therapy (EVT) for acute ischemic stroke. A better understanding could optimize in-hospital surveillance time points and duration. The aim of this study was to delineate the probability of sICH over time and to identify factors associated with its timing. Patients and methods: We retrospectively analyzed data from the Dutch MR CLEAN trial and MR CLEAN Registry. We included adult patients who underwent EVT for an anterior circulation large vessel occlusion within 6.5 h of stroke onset. In patients with sICH (defined as ICH causing an increase of ⩾4 points on the National Institutes of Health Stroke Scale [NIHSS]), univariable and multivariable linear regression analysis was used to identify factors associated with the timing of sICH. This was defined as the time between end of EVT and the time of first CT-scan on which ICH was seen as a proxy. Results: SICH occurred in 205 (6%) of 3391 included patients. Median time from end of EVT procedure to sICH detection on NCCT was 9.0 [IQR 2.9–22.5] hours, with a rapidly decreasing incidence after 24 h. None of the analyzed factors, including baseline NIHSS, intravenous alteplase treatment, and poor reperfusion at the end of the procedure were associated with the timing of sICH. Conclusion: SICHs primarily occur in the first hours after EVT, and less frequently beyond 24 h. Guidelines that recommend to perform frequent neurological assessments for at least 24 h after intravenous alteplase treatment can be applied to ischemic stroke patients treated with EVT.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Timing of symptomatic intracranial hemorrhage after endovascular stroke treatment

Steen

Ende

Kranendonk

et al. 2022

European Stroke Journal

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“…Our observation that patients with parenchymal or petechial HT progress more rapidly toward LTME may be in part due to the natural timeline of HT. Median time to symptomatic HT after tPA administration has been shown to be 18.25 h 18 , and may accelerate swelling from ischemia-related cerebral edema, which traditionally is thought to peak at 48–72 h after stroke onset 1 . We also found that patients with parenchymal and petechial HT had higher maximum MLS and were more likely to receive hyperosmolar therapy and DHC.…”

Section: Discussionmentioning

confidence: 99%

Association of large core middle cerebral artery stroke and hemorrhagic transformation with hospitalization outcomes

Pohlmann,

Kim,

Brush

et al. 2024

Sci Rep

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Historically, investigators have not differentiated between patients with and without hemorrhagic transformation (HT) in large core ischemic stroke at risk for life-threatening mass effect (LTME) from cerebral edema. Our objective was to determine whether LTME occurs faster in those with HT compared to those without. We conducted a two-center retrospective study of patients with ≥ 1/2 MCA territory infarct between 2006 and 2021. We tested the association of time-to-LTME and HT subtype (parenchymal, petechial) using Cox regression, controlling for age, mean arterial pressure, glucose, tissue plasminogen activator, mechanical thrombectomy, National Institute of Health Stroke Scale, antiplatelets, anticoagulation, temperature, and stroke side. Secondary and exploratory outcomes included mass effect-related death, all-cause death, disposition, and decompressive hemicraniectomy. Of 840 patients, 358 (42.6%) had no HT, 403 (48.0%) patients had petechial HT, and 79 (9.4%) patients had parenchymal HT. LTME occurred in 317 (37.7%) and 100 (11.9%) had mass effect-related deaths. Parenchymal (HR 8.24, 95% CI 5.46–12.42, p < 0.01) and petechial HT (HR 2.47, 95% CI 1.92–3.17, p < 0.01) were significantly associated with time-to-LTME and mass effect-related death. Understanding different risk factors and sequelae of mass effect with and without HT is critical for informed clinical decisions.

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“…5 However, these treatments have a sharp treatment time window and a severe hemorrhagic risk, and only a small number of patients benefit. [6][7][8] Drug therapy in the acute and convalescence stages plays an important role. At present, American Heart Association/American Society of Anesthesiologists guidelines recommend statin treatment and neuroprotection for ischemic stroke to improve cerebral circulation.…”

Section: Introductionmentioning

confidence: 99%

Cost-Effectiveness Analysis of Ginkgolide Injection in the Treatment of Ischemic Stroke Based on a Randomized Clinical Trial

Xiang

Yang

Guo

et al. 2021

The Journal of Alternative and Complementary Medicine

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Objective: To evaluate the long-term cost-effectiveness of ginkgolide plus aspirin compared with placebo plus aspirin treatment of ischemic stroke. Background: Stroke is the leading cause of death and long-term disability in China, with high incidence, high mortality, and heavy disease burden. In addition to Western medicines, Chinese clinical guidelines for diagnosis and treatment of acute ischemic stroke recommend application of Chinese patent medicines. Ginkgolide injection is commonly used in the clinical treatment of stroke in China to promote blood circulation and remove blood stasis. The economy of ginkgolide injection needs to be evaluated. Methods: A Markov model was constructed consisting of four disease states: no significant disability, disability, stroke recurrence, and death. Therapeutic data were taken from the Ginkgolide in Ischemic Stroke Patients with Large Artery Atherosclerosis (GISAA) study. Utilities and transition probabilities were extracted from the literature. Cost data were obtained from the China Health Statistics Yearbook and hospital record survey. Expected costs and quality-adjusted life-years (QALYs) of 13 years of cycles (calculated by average age of subjects and Chinese life expectancy) were calculated through TreeAge Pro11 software. The willingness-to-pay (WTP) threshold was set as the Chinese per capita Gross Domestic Product (GDP) in 2019, CNU70,892/QALY. The results were analyzed by single factor and probability sensitivity analyses. Results: Ginkgolide plus aspirin had a higher expected per-patient cost than placebo plus aspirin but a higher QALYs. Compared with placebo plus aspirin, ginkgolide plus aspirin produced an incremental costeffectiveness ratio of CNU14,866.06/QALY, which is below the WTP threshold. Probabilistic sensitivity analysis suggested the acceptability of ginkgolide plus aspirin was higher than that of placebo plus aspirin. Conclusions: The present cost-effectiveness analysis showed that addition of ginkgolides to conventional treatment is cost-effective at a threshold the Chinese per capita GDP.

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Timing of symptomatic intracerebral hemorrhage after rt-PA treatment in ischemic stroke

Cited by 4 publications

References 10 publications

Timing of symptomatic intracranial hemorrhage after endovascular stroke treatment

Timing of symptomatic intracranial hemorrhage after endovascular stroke treatment

Association of large core middle cerebral artery stroke and hemorrhagic transformation with hospitalization outcomes

Cost-Effectiveness Analysis of Ginkgolide Injection in the Treatment of Ischemic Stroke Based on a Randomized Clinical Trial

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