Cerebral Amyloid Angiopathy: A Hidden Risk for IV Thrombolysis?
Recombinant tissue plasminogen activator (t-PA) is the only FDA approved therapy for acute ischemic stroke. Cerebral microbleeds (CMBs) or cerebral amyloid angiopathy (CAA) are currently not contraindications, however, data regarding this complex issue are limited. We report 2 cases of fatal intracerebral hemorrhage (sICH) after IV t-PA, each with evidence of CAA. Patients with CAA may have increased risk for IV thrombolysis-associated sICH. We highlight the severe and catastrophic pattern of ICH, which may be a defining characteristic, and discuss the limitations of our current understanding of the risk of thrombolysis-associated ICH in patients with CAA and/or CMBs.
Department of Neurology, Johns Hopkins University School of Medicine, USA.
Ryan J
RJ
Felling
Department of Pathology, Johns Hopkins University School of Medicine, USA.
Roland
R
Faigle
Cheng-Ying
CY
Ho
Rafael H
RH
Llinas
Victor C
VC
Urrutia
CAA; Intracerebral hemorrhage; Microhemorrhage; RT-PA