Safety of thrombolysis in patients with acute ischemic stroke and cerebral cavernous malformations.
OBJECTIVE
Data on safety of intravenous thrombolysis with recombinant tissue-type plasminogen activator for acute ischemic stroke in patients with coexisting cerebral cavernous malformations (CCMs) are scarce. We assessed the risk of thrombolysis-associated hemorrhage in these patients.


METHODS
We searched our tertiary care hospital thrombolysis register for patients with CCM confirmed by MRI (3 T, Siemens, TimTrio) before thrombolysis for acute ischemic stroke. CCMs were graded into subtypes according to the Zabramski classification on the basis of their MRI appearance. The primary end point was symptomatic intracerebral hemorrhage according to European Cooperative Acute Stroke Study III (ECASS III) criteria. The secondary end point was any parenchymal hemorrhage.


RESULTS
In a total of 350 patients (median age, 76 years; interquartile range, 68-84; median National Institutes of Health Stroke Scale score, 8; interquartile range, 5-14; 51.4% women), CCMs were found in 9 patients (2.6%). Seven patients had a single CCM, and 2 patients had multiple CCMs with a total number of 12 CCMs in all patients. The subtype of CCMs was type III in 9 cases and type I in 3 cases. Symptomatic intracerebral hemorrhage occurred in 1 of 9 patients with CCM versus 11 of 341 patients without CCM (P=0.27). Parenchymal hemorrhage occurred in 2 of 9 patients with CCM versus 27 of 341 patients (P=0.17) without CCM.


CONCLUSIONS
Given the limitations of our study (mainly low number of patients with CCM), the risk of thrombolysis-associated hemorrhage in patients with CCM remains uncertain. Although our data do not suggest an increased hazard from thrombolysis in patients with CCM, larger studies are necessary to determine definitively the influence of CCMs on parenchymal hemorrhage and symptomatic intracerebral hemorrhage.
From the Department of Neurology (H.E., J.F.S., S.T., M.E., C.H.N.), Center for Stroke Research Berlin (J.F.S., J.B.F., M.E., C.H.N.), and NeuroCure, Cluster of Excellence (M.E.), Charité - Universitätsmedizin Berlin, Berlin, Germany; and Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, United Kingdom (D.J.W.). hebun.erdur@charite.de.
Hebun
H
Erdur
From the Department of Neurology (H.E., J.F.S., S.T., M.E., C.H.N.), Center for Stroke Research Berlin (J.F.S., J.B.F., M.E., C.H.N.), and NeuroCure, Cluster of Excellence (M.E.), Charité - Universitätsmedizin Berlin, Berlin, Germany; and Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, United Kingdom (D.J.W.).
Jan F
JF
Scheitz
From the Department of Neurology (H.E., J.F.S., S.T., M.E., C.H.N.), Center for Stroke Research Berlin (J.F.S., J.B.F., M.E., C.H.N.), and NeuroCure, Cluster of Excellence (M.E.), Charité - Universitätsmedizin Berlin, Berlin, Germany; and Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, United Kingdom (D.J.W.).
Serdar
S
Tütüncü
From the Department of Neurology (H.E., J.F.S., S.T., M.E., C.H.N.), Center for Stroke Research Berlin (J.F.S., J.B.F., M.E., C.H.N.), and NeuroCure, Cluster of Excellence (M.E.), Charité - Universitätsmedizin Berlin, Berlin, Germany; and Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, United Kingdom (D.J.W.).
Jochen B
JB
Fiebach
From the Department of Neurology (H.E., J.F.S., S.T., M.E., C.H.N.), Center for Stroke Research Berlin (J.F.S., J.B.F., M.E., C.H.N.), and NeuroCure, Cluster of Excellence (M.E.), Charité - Universitätsmedizin Berlin, Berlin, Germany; and Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, United Kingdom (D.J.W.).
Matthias
M
Endres
From the Department of Neurology (H.E., J.F.S., S.T., M.E., C.H.N.), Center for Stroke Research Berlin (J.F.S., J.B.F., M.E., C.H.N.), and NeuroCure, Cluster of Excellence (M.E.), Charité - Universitätsmedizin Berlin, Berlin, Germany; and Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, United Kingdom (D.J.W.).
David J
DJ
Werring
From the Department of Neurology (H.E., J.F.S., S.T., M.E., C.H.N.), Center for Stroke Research Berlin (J.F.S., J.B.F., M.E., C.H.N.), and NeuroCure, Cluster of Excellence (M.E.), Charité - Universitätsmedizin Berlin, Berlin, Germany; and Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, United Kingdom (D.J.W.).
Christian H
CH
Nolte
D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000473:pathology / Q000628:therapy*; D005260:Female; D020786:Hemangioma, Cavernous, Central Nervous System / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008297:Male; D012449:Safety; D020521:Stroke / Q000473:pathology / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*
hemangioma, cavernous; hemangioma, cavernous, central nervous system; hemorrhage; stroke; thrombolytic therapy