title: What causes intracerebral bleeding after thrombolysis for acute ischaemic stroke? Recent insights into mechanisms and potential biomarkers.
abstract: The overall population benefit of intravascular recombinant tissue plasminogen activator (rtPA) on functional outcome in ischaemic stroke is clear, but there are some treated patients who are harmed by early symptomatic intracranial haemorrhage (ICH). Although several clinical and radiological factors increase the risk of rtPA-related ICH, none of the currently available risk prediction tools are yet useful for practical clinical decision-making, probably reflecting our limited understanding of the underlying mechanisms. Finding new methods to identify patients at highest risk of rtPA-related ICH, or new measures to limit risk, are urgent challenges in acute stroke therapy research. In this article, we focus on the potential underlying mechanisms of rtPA-related ICH, highlight promising candidate risk biomarkers and suggest future research directions.
authors: University College London, Institute of Neurology & National Hospital for Neurology and Neurosurgery, Stroke Research Group, London, UK Department of Adult Neurology, Medical University of Gdansk & University Clinical Centre, Gdansk, Poland.
authors: Bartosz
authors: B
authors: Karaszewski
authors: Department of Molecular Neuroscience, University College London, Institute of Neurology & National Hospital for Neurology and Neurosurgery, London, UK.
authors: Henry
authors: H
authors: Houlden
authors: Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.
authors: Eric E
authors: EE
authors: Smith
authors: Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK.
authors: Hugh S
authors: HS
authors: Markus
authors: University College London, Institute of Neurology & National Hospital for Neurology and Neurosurgery, Stroke Research Group, London, UK.
authors: Andreas
authors: A
authors: Charidimou
authors: Acute Stroke Services, University of Newcastle, John Hunter Hospital, Newcastle, New South Wales, Australia.
authors: Christopher
authors: C
authors: Levi
authors: University College London, Institute of Neurology & National Hospital for Neurology and Neurosurgery, Stroke Research Group, London, UK.
authors: David J
authors: DJ
authors: Werring
mesh_terms: D015415:Biomarkers; D002545:Brain Ischemia / Q000150:complications* / Q000628:therapy*; D002543:Cerebral Hemorrhage / Q000209:etiology*; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D010960:Plasminogen Activators / Q000009:adverse effects / Q000627:therapeutic use; D020521:Stroke / Q000150:complications* / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects*
chemical_list: D015415:Biomarkers; D005343:Fibrinolytic Agents; D010960:Plasminogen Activators
keywords: CEREBROVASCULAR DISEASE; NEURORADIOLOGY; STROKE