Severe Hemorrhagic Transformation after Thrombolysis for Acute Ischemic Stroke Prevents Early Neurological Improvement.
BACKGROUND
Intravenous thrombolysis can improve neurological outcomes after acute ischemic stroke (AIS), but hemorrhagic transformation (HT) of the infarct remains a risk. Current definitions for symptomatic intracerebral hemorrhage (ICH) all entail that there be some degree of associated neurological deterioration. However, early deleterious effects of secondary ICH might also be manifested as reduced neurological improvement. This study aims to investigate whether there are any independent associations between different radiological subtypes of HT and the degree of neurological improvement 24 hours after thrombolysis.


METHODS
This study is a retrospective analysis of a single-center database of consecutive thrombolysis cases for AIS. Multivariate regression analysis was undertaken to explore the relationship between different subtypes of HT with changes in National Institutes of Health Stroke Scale (NIHSS) score 24 hours after thrombolysis, after adjusting for potential confounders.


RESULTS
As compared to cases with no HT, occurrence of the parenchymal hematoma 2 (PH2) subtype of secondary ICH was independently associated with reduced improvement or worsening in the NIHSS score, with an average effect size of 7 points (95% confidence interval -10 to -4, P < .001). In the absence of PH2, thrombolysis for AIS was generally associated with an improvement in the neurological status at 24 hours.


CONCLUSIONS
The PH2 subtype of HT is associated with reduced neurological improvement or deterioration 24 hours after thrombolysis for AIS.
Imperial College Healthcare NHS Trust, Imperial College London, Postgraduate Centre, Hammersmith Hospital, London, United Kingdom. Electronic address: Dipender.gill@imperial.ac.uk.
Dipender
D
Gill
University College London Hospitals NHS Foundation Trust, University College London Hospital, London, United Kingdom.
Aravindhan
A
Baheerathan
Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom.
Adarsh
A
Aravind
Division of Brain Sciences, Department of Stroke Medicine, Imperial College London, London, United Kingdom.
Roland
R
Veltkamp
Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom.
Arindam
A
Kar
D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000187:drug effects; D002545:Brain Ischemia / Q000150:complications; D002543:Cerebral Hemorrhage / Q000139:chemically induced*; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology* / Q000517:prevention & control*; D012044:Regression Analysis; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications* / Q000188:drug therapy* / Q000209:etiology; D010959:Tissue Plasminogen Activator / Q000009:adverse effects*
D001786:Blood Glucose; D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
Intracerebral hemorrhage; hemorrhagic transformation; ischemic stroke; rtPA; stroke subtype; thrombolysis