Risk for symptomatic intracerebral hemorrhage after thrombolysis assessed by diffusion-weighted magnetic resonance imaging.
OBJECTIVE
The risk for symptomatic intracerebral hemorrhage (sICH) associated with thrombolytic treatment has not been evaluated in large studies using diffusion-weighted imaging (DWI). Here, we investigated the relation between pretreatment DWI lesion size and the risk for sICH after thrombolysis.


METHODS
In this retrospective multicenter study, prospectively collected data from 645 patients with anterior circulation stroke treated with intravenous or intraarterial thrombolysis within 6 hours (<3 hours: n = 320) after symptom onset were pooled. Patients were categorized according to the pretreatment DWI lesion size into three prespecified groups: small (< or =10 ml; n = 218), moderate (10-100 ml; n = 371), and large (>100 ml; n = 56) DWI lesions.


RESULTS
In total, 44 (6.8%) patients experienced development of sICH. The sICH rate was significantly different between subgroups: 2.8, 7.8, and 16.1% in patients with small, moderate, and large DWI lesions, respectively (p < 0.05). This translates to a 5.8 (2.8)-fold greater sICH risk for patients with large DWI lesions as compared with patients with small (or moderate) DWI lesions. The results were similar in the large subgroup (n = 536) of patients treated with intravenous tissue plasminogen activator. DWI lesion size remained an independent risk factor when including National Institutes of Health Stroke Scale, age, time to thrombolysis, and leukoariosis in a logistic regression analysis.


CONCLUSIONS
This multicenter study provides estimates of sICH risk in potential candidates for thrombolysis. The sICH risk increases gradually with increasing DWI lesion size, indicating that the potential benefit of therapy needs to be balanced carefully against the risk for sICH, especially in patients with large DWI lesions.
Singer
Oliver C
OC
Klinik für Neurologie, Universitätsklinik, Johann Wolfgang von Goethe-Universität, Frankfurt, Germany. o.singer@em.uni-frankfurt.de
Humpich
Marek C
MC
Fiehler
Jens
J
Albers
Gregory W
GW
Lansberg
Maarten G
MG
Kastrup
Andiras
A
Rovira
Alex
A
Liebeskind
David S
DS
Gass
Achim
A
Rosso
Charlotte
C
Derex
Laurent
L
Kim
Jong S
JS
Neumann-Haefelin
Tobias
T
D000368:Aged; D020520:Brain Infarction / Q000188:drug therapy; D002545:Brain Ischemia / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D002536:Cerebral Arteries / Q000187:drug effects* / Q000473:pathology* / Q000503:physiopathology; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000473:pathology* / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000187:drug effects / Q000502:physiology; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects; D006801:Humans; D020767:Intracranial Thrombosis / Q000188:drug therapy*; D049292:Leukoaraiosis / Q000139:chemically induced / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009413:Nerve Fibers, Myelinated / Q000187:drug effects / Q000473:pathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D015912:Thrombolytic Therapy / Q000009:adverse effects*
D005343:Fibrinolytic Agents