title: Timing of Symptomatic Infarct Swelling Following Intravenous Thrombolysis in Acute Middle Cerebral Artery Infarction: A Case-Control Study.
abstract: BACKGROUND
  The risk of symptomatic infarct swelling has been reported to be higher in patients treated with recombinant tissue plasminogen activator (rt-PA). The aim of this study was to evaluate the timing of symptomatic infarct swelling after rt-PA treatment.
  
  
  METHODS
  We retrospectively analyzed 14 868 patients with acute ischemic stroke from a stroke registry databank. We recruited patients with massive middle cerebral artery (MCA) infarction and symptomatic infarct swelling and excluded those with parenchymal or symptomatic hemorrhage. Multiple linear regression and multivariate logistic regression analyses were used to estimate the impact of rt-PA on the timing of symptomatic infarct swelling.
  
  
  RESULTS
  A total of 23 patients with rt-PA treatment and 117 patients without rt-PA treatment were included. The rt-PA treatment group had a lower rate of coronary artery disease (8.7% vs 32.5%; P = .023), lower severity of baseline National Institutes of Health Stroke Scale score (19 vs 23; P = .014), shorter duration of infarct swelling (27.6 vs 45.4 hours; P < .001), and higher rate of hemicraniectomy surgery (65.2% vs 28.2%; P =.001) than those without rt-PA treatment. After adjusting for variables in multiple linear regression analysis, rt-PA treatment and an elevated C-reactive protein level were associated with early symptomatic infarct swelling ( P = .014 and P = .041, respectively). The rt-PA treatment was an independent factor related to early symptomatic infarct swelling within 36 hours ( P = .005; odds ratio [OR]: 5.3; confidence interval [CI]: 1.65-17.0) or 48 hours ( P = .009; OR: 16.4; CI: 2.00-134).
  
  
  CONCLUSIONS
  Intravenous rt-PA treatment may hasten the onset of cerebral edema and subsequent cerebral herniation in large MCA territory infarction.
authors.affiliation: 1 Department of Neurology, Taipei Medical University Hospital, Taipei, Taiwan.
authors.forename: Ting-Chun
authors.initials: TC
authors.lastname: Lin
authors.affiliation: 2 Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi, Taiwan.
authors.forename: Jiann-Der
authors.initials: JD
authors.lastname: Lee
authors.affiliation: 2 Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi, Taiwan.
authors.forename: Ya-Hui
authors.initials: YH
authors.lastname: Lin
authors.affiliation: 1 Department of Neurology, Taipei Medical University Hospital, Taipei, Taiwan.
authors.forename: Rey-Yue
authors.initials: RY
authors.lastname: Yuan
authors.affiliation: 3 Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Taiwan.
authors.forename: Hsu-Huei
authors.initials: HH
authors.lastname: Weng
authors.affiliation: 2 Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi, Taiwan.
authors.forename: Ying-Chih
authors.initials: YC
authors.lastname: Huang
authors.affiliation: 2 Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi, Taiwan.
authors.forename: Meng
authors.initials: M
authors.lastname: Lee
authors.affiliation: 2 Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi, Taiwan.
authors.forename: Chih-Ying
authors.initials: CY
authors.lastname: Wu
authors.affiliation: 2 Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi, Taiwan.
authors.forename: Huan-Lin
authors.initials: HL
authors.lastname: Hsu
authors.affiliation: 2 Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi, Taiwan.
authors.forename: Chia-Yu
authors.initials: CY
authors.lastname: Hsu
authors.affiliation: 4 Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Tsong-Hai
authors.initials: TH
authors.lastname: Lee
authors.affiliation: 4 Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Shan-Jin
authors.initials: SJ
authors.lastname: Liu
authors.affiliation: 4 Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Yeu-Jhy
authors.initials: YJ
authors.lastname: Chang
authors.affiliation: 4 Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Chien-Hung
authors.initials: CH
authors.lastname: Chang
authors.affiliation: 5 Stroke Center and Department of Neurology, Chang Gung Memorial Hospital at Keelung, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Tsung-I
authors.initials: TI
authors.lastname: Peng
authors.affiliation: 6 Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Chia-Wei
authors.initials: CW
authors.lastname: Liou
authors.affiliation: 6 Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Ku-Chou
authors.initials: KC
authors.lastname: Chang
authors.affiliation: 2 Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi, Taiwan.
authors.forename: Yi-Ting
authors.initials: YT
authors.lastname: Pan
authors.affiliation: 2 Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi, Taiwan.
authors.forename: Yen-Chu
authors.initials: YC
authors.lastname: Huang
mesh_terms: D001929:Brain Edema; D002097:C-Reactive Protein / Q000032:analysis; D016022:Case-Control Studies; D003324:Coronary Artery Disease; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000188:drug therapy / Q000473:pathology*; D012042:Registries; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000473:pathology; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D010959:Tissue Plasminogen Activator / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D002097:C-Reactive Protein; D010959:Tissue Plasminogen Activator
keywords: edema; infarction; middle cerebral artery occlusion; thrombolysis