Remote or extraischemic intracerebral hemorrhage--an uncommon complication of stroke thrombolysis: results from the safe implementation of treatments in stroke-international stroke thrombolysis register.
OBJECTIVE
Intracerebral hemorrhage after treatment with intravenous recombinant tissue-type plasminogen activator for ischemic stroke can occur in local relation to the infarct, as well as in brain areas remote from infarcted tissue. We aimed to describe risk factors, 3-month mortality, and functional outcome in patients with the poorly understood complication of remote intracerebral hemorrhage, as well as local intracerebral hemorrhage.


METHODS
In this study, 43 494 patients treated with intravenous recombinant tissue-type plasminogen activator, with complete imaging data, were enrolled in the Safe Implementation of Treatments in Stroke-International Stroke Thrombolysis Register (SITS-ISTR) during 2002 to 2011. Baseline data were compared among 970 patients (2.2%) with remote parenchymal hemorrhage (PHr), 2325 (5.3%) with PH, 438 (1.0%) with both PH and PHr, and 39 761 (91.4%) without PH or PHr. Independent risk factors for all hemorrhage types were obtained by multivariate logistic regression.


RESULTS
Previous stroke (P=0.023) and higher age (P<0.001) were independently associated with PHr, but not with PH. Atrial fibrillation, computed tomographic hyperdense cerebral artery sign, and elevated blood glucose were associated with PH, but not with PHr. Female sex had a stronger association with PHr than with PH. Functional independence at 3 months was more common in PHr than in PH (34% versus 24%; P<0.001), whereas 3-month mortality was lower (34% versus 39%; P<0.001).


CONCLUSIONS
Differences between risk factor profiles indicate an influence of previous vascular pathology in PHr and acute large-vessel occlusion in PH. Additional research is needed on the effect of pre-existing cerebrovascular disease on complications of recanalization therapy in acute ischemic stroke.
From the Department of Neurology, Karolinska University Hospital (M.V.M., N.A., N.W.) and Department of Clinical Neuroscience (M.V.M., N.A., N.W.), Karolinska Institutet, Stockholm, Sweden; Stroke Research Group, Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, Tyne and Wear, United Kingdom (G.A.F.); Department of Neurology, University of Leipzig, Leipzig, Germany (C.H.); International Clinical Research Center, Neurology Department, St Anne's Hospital, Brno, Czech Republic (R.M.); and Stroke Unit, Centro Hospitalar Lisboa Central, Lisbon, Portugal (A.P.N.). michael.mazya@karolinska.se.
Michael V
MV
Mazya
From the Department of Neurology, Karolinska University Hospital (M.V.M., N.A., N.W.) and Department of Clinical Neuroscience (M.V.M., N.A., N.W.), Karolinska Institutet, Stockholm, Sweden; Stroke Research Group, Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, Tyne and Wear, United Kingdom (G.A.F.); Department of Neurology, University of Leipzig, Leipzig, Germany (C.H.); International Clinical Research Center, Neurology Department, St Anne's Hospital, Brno, Czech Republic (R.M.); and Stroke Unit, Centro Hospitalar Lisboa Central, Lisbon, Portugal (A.P.N.).
Niaz
N
Ahmed
From the Department of Neurology, Karolinska University Hospital (M.V.M., N.A., N.W.) and Department of Clinical Neuroscience (M.V.M., N.A., N.W.), Karolinska Institutet, Stockholm, Sweden; Stroke Research Group, Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, Tyne and Wear, United Kingdom (G.A.F.); Department of Neurology, University of Leipzig, Leipzig, Germany (C.H.); International Clinical Research Center, Neurology Department, St Anne's Hospital, Brno, Czech Republic (R.M.); and Stroke Unit, Centro Hospitalar Lisboa Central, Lisbon, Portugal (A.P.N.).
Gary A
GA
Ford
From the Department of Neurology, Karolinska University Hospital (M.V.M., N.A., N.W.) and Department of Clinical Neuroscience (M.V.M., N.A., N.W.), Karolinska Institutet, Stockholm, Sweden; Stroke Research Group, Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, Tyne and Wear, United Kingdom (G.A.F.); Department of Neurology, University of Leipzig, Leipzig, Germany (C.H.); International Clinical Research Center, Neurology Department, St Anne's Hospital, Brno, Czech Republic (R.M.); and Stroke Unit, Centro Hospitalar Lisboa Central, Lisbon, Portugal (A.P.N.).
Carsten
C
Hobohm
From the Department of Neurology, Karolinska University Hospital (M.V.M., N.A., N.W.) and Department of Clinical Neuroscience (M.V.M., N.A., N.W.), Karolinska Institutet, Stockholm, Sweden; Stroke Research Group, Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, Tyne and Wear, United Kingdom (G.A.F.); Department of Neurology, University of Leipzig, Leipzig, Germany (C.H.); International Clinical Research Center, Neurology Department, St Anne's Hospital, Brno, Czech Republic (R.M.); and Stroke Unit, Centro Hospitalar Lisboa Central, Lisbon, Portugal (A.P.N.).
Robert
R
Mikulik
From the Department of Neurology, Karolinska University Hospital (M.V.M., N.A., N.W.) and Department of Clinical Neuroscience (M.V.M., N.A., N.W.), Karolinska Institutet, Stockholm, Sweden; Stroke Research Group, Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, Tyne and Wear, United Kingdom (G.A.F.); Department of Neurology, University of Leipzig, Leipzig, Germany (C.H.); International Clinical Research Center, Neurology Department, St Anne's Hospital, Brno, Czech Republic (R.M.); and Stroke Unit, Centro Hospitalar Lisboa Central, Lisbon, Portugal (A.P.N.).
A Paiva
AP
Nunes
From the Department of Neurology, Karolinska University Hospital (M.V.M., N.A., N.W.) and Department of Clinical Neuroscience (M.V.M., N.A., N.W.), Karolinska Institutet, Stockholm, Sweden; Stroke Research Group, Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, Tyne and Wear, United Kingdom (G.A.F.); Department of Neurology, University of Leipzig, Leipzig, Germany (C.H.); International Clinical Research Center, Neurology Department, St Anne's Hospital, Brno, Czech Republic (R.M.); and Stroke Unit, Centro Hospitalar Lisboa Central, Lisbon, Portugal (A.P.N.).
Nils
N
Wahlgren
D000367:Age Factors; D000368:Aged; D002545:Brain Ischemia / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000401:mortality; D002543:Cerebral Hemorrhage / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000401:mortality; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D010959:Tissue Plasminogen Activator / Q000009:adverse effects* / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator
cerebral hemorrhage; cerebral infarction; database; prognosis; thrombolytic therapy