Intravenous tissue plasminogen activator before endovascular treatment increases symptomatic intracranial hemorrhage in patients with occlusion of the middle cerebral artery second division: subanalysis of the RESCUE-Japan Registry.
BACKGROUND
No previous study has investigated the relationship between intravenous tissue plasminogen activator (IV t-PA) and intracranial hemorrhage (ICH) according to the location of vessel occlusion. The aim of the present study was to investigate the relationship between preprocedural IV t-PA and endovascular treatment (EVT) and ICH according to the location of occlusion using data from the nationwide prospective registry of acute cerebral large vessel occlusion (LVO), the RESCUE-Japan Registry.


METHODS
Among 1442 patients with acute LVO enrolled in the registry, we examined 410 patients who received EVT. Patients were divided into the following four groups according to the location of occlusion: the internal carotid artery (ICA), middle cerebral artery first division (M1), middle cerebral artery second division (M2), and vertebral artery (VA)/basilar artery (BA) groups.


RESULTS
A total of 399 patients in whom the occlusion was located in these vessels were finally included. Any ICH (aICH) was identified in 127 (30.9%) patients, and symptomatic ICH (sICH) was identified in 20 (4.9%). Preprocedural IV t-PA did not increase the incidence of aICH in any group and tended to increase the incidence of sICH in only the M2 group. In multivariate analysis of the M2 group, IV t-PA was an independent risk factor for sICH.


CONCLUSIONS
Preprocedural IV t-PA did not increase the incidence of ICH in total, but could increase the incidence of sICH in those with M2 occlusion. IV t-PA before EVT may be an independent risk factor for sICH in patients with M2 occlusion.
Department of Neurosurgery, Gifu Prefectural Gero Hot Spring Hospital, Gifu, Japan.
Toshinori
T
Takagi
Department of Neurosurgery, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya, Hyogo, 663-8501, Japan. s-yoshi@hyo-med.ac.jp.
Shinichi
S
Yoshimura
Department of Neurosurgery, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya, Hyogo, 663-8501, Japan.
Kazutaka
K
Uchida
Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan.
Yukiko
Y
Enomoto
Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan.
Yusuke
Y
Egashira
Department of Medicine, Cerebrovascular Division, National Cerebral Cardiovascular Center, Osaka, Japan.
Hiroshi
H
Yamagami
Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan.
Nobuyuki
N
Sakai
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015984:Causality; D002533:Cerebral Angiography / Q000706:statistics & numerical data; D015897:Comorbidity; D057510:Endovascular Procedures; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D015994:Incidence; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D007275:Injections, Intravenous; D020300:Intracranial Hemorrhages / Q000000981:diagnostic imaging / Q000401:mortality*; D007564:Japan / Q000453:epidemiology; D008297:Male; D061185:Mechanical Thrombolysis / Q000401:mortality* / Q000706:statistics & numerical data; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control; D011292:Premedication / Q000401:mortality* / Q000706:statistics & numerical data; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000401:mortality / Q000517:prevention & control; D015996:Survival Rate; D063189:Symptom Assessment; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
Endovascular treatment; Intracranial hemorrhage; Intravenous tissue plasminogen activator; Mechanical thrombectomy; The middle cerebral artery