title: Reduced pretreatment ipsilateral middle cerebral artery cerebral blood flow is predictive of symptomatic hemorrhage post-intra-arterial thrombolysis in patients with middle cerebral artery occlusion.
abstract: OBJECTIVE
  Intracerebral hemorrhage (ICH) can be a devastating complication associated with thrombolytic therapy for acute ischemic stroke. We hypothesized that patients with lower prethrombolysis cerebral blood flow (CBF) were at a higher risk of symptomatic ICH (sICH).
  
  
  METHODS
  Twenty-three patients who underwent quantitative CBF assessment with Xenon CT studies for acute stroke before intra-arterial (IA) thrombolysis for a middle cerebral artery (MCA) or internal carotid artery terminus occlusion within 6 hours of symptom onset were studied. Univariate and multivariate analysis were carried out to determine predictors of sICH post-IA thrombolysis. Receiver operating characteristic curves were generated to determine the association between mean ipsilateral CBF and the occurrence of sICH.
  
  
  RESULTS
  The mean age of our cohort was 68+/-12 years and a mean National Institutes of Health Stroke Scale (NIHSS) score of 18+/-3. In univariate analysis, patients with higher percent of core infarct, hyperglycemia, and reduced mean ipsilateral CBF were at risk of sICH. In multivariate analysis only mean ipsilateral CBF was associated with higher rates of sICH (odds ratio 1.58; 95% CI, 1.01 to 2.51; P<0.04). The area under the receiver operating characteristic curve was 0.87 (95% CI, 0.76 to 0.97; P<0.005).
  
  
  CONCLUSIONS
  Patients with lower pre-IA thrombolysis mean ipsilateral MCA CBF are at significantly higher risk for sICH in the setting of a MCA or carotid terminus occlusion. The threshold identified in this study may be useful for selection of patients with acute MCA occlusions for acute stroke thrombolysis.
authors.affiliation: Department of Neurology, Stroke Institute, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213, USA.
authors.forename: Rishi
authors.initials: R
authors.lastname: Gupta
authors.forename: Howard
authors.initials: H
authors.lastname: Yonas
authors.forename: James
authors.initials: J
authors.lastname: Gebel
authors.forename: Steven
authors.initials: S
authors.lastname: Goldstein
authors.forename: Michael
authors.initials: M
authors.lastname: Horowitz
authors.forename: Stephen Z
authors.initials: SZ
authors.lastname: Grahovac
authors.forename: Lawrence R
authors.initials: LR
authors.lastname: Wechsler
authors.forename: Maxim D
authors.initials: MD
authors.lastname: Hammer
authors.forename: Ken
authors.initials: K
authors.lastname: Uchino
authors.forename: Tudor G
authors.initials: TG
authors.lastname: Jovin
mesh_terms: D000368:Aged; D019540:Area Under Curve; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D002560:Cerebrovascular Circulation; D015331:Cohort Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications / Q000188:drug therapy*; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000503:physiopathology*; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000009:adverse effects*
chemical_list: D005343:Fibrinolytic Agents