title: Orolingual angioedema after thrombolysis is not associated with insular cortex ischemia on pre-thrombolysis CT.
abstract: OBJECTIVE
  Orolingual angioedema (OA) is a well known early complication of treatment with alteplase in ischemic stroke patients. Our aim was to study risk factors for OA in these patients, namely insular cortex ischemia.
  
  
  METHODS
  Retrospective case-cohort study using the prospective registry of all consecutive ischemic stroke patients submitted to intravenous thrombolysis with alteplase. Clinical data was retrieved from the registry and medical records. Two independent observers evaluated early signs of insular cortex ischemia on pre-thrombolysis computed tomography (CT) and of insular cortex infarct on early follow-up imaging. Univariate and multivariate analysis were performed to identify predictors of OA.
  
  
  RESULTS
  Of the 659 patients with acute ischemic stroke treated with alteplase, 32 developed OA (4.9%, 95%CI=3.3-6.6). Frequency of early signs of insular cortex ischemia on pre-thrombolysis CT and of insular cortex infarct on follow-up imaging was similar in patients with and without OA (p=0.241 and p=0.145, respectively). The only independent predictors of OA occurrence were female sex (OR=5.47, 95%CI=1.98-15.10) and angiotensin-converting enzyme inhibitor (ACE-I) use (OR=3.87, 95%CI=1.71-8.75).
  
  
  CONCLUSIONS
  Female sex and ACE-I use are independent risk factors for OA occurrence in ischemic stroke patients treated with alteplase. Early signs of insular cortex ischemia on pre-thrombolysis CT were not significantly associated with OA.
authors.affiliation: Neurology Department, Hospital de Braga. Sete Fontes, São Victor, 4710-243 Braga, Portugal. Electronic address: Joao.Pinho@hospitaldebraga.pt.
authors.forename: João
authors.initials: J
authors.lastname: Pinho
authors.affiliation: Neurology Department, Hospital de Braga. Sete Fontes, São Victor, 4710-243 Braga, Portugal. Electronic address: jose.nuno.aalves@gmail.com.
authors.forename: José Nuno
authors.initials: JN
authors.lastname: Alves
authors.affiliation: Internal Medicine Department, Unidade de Famalicão, Centro Hospitalar do Médio Ave. Rua Cupertino de Miranda, 4761-917 Vila Nova de Famalicão, Portugal. Electronic address: liliana.oliveira.medicina@gmail.com.
authors.forename: Liliana
authors.initials: L
authors.lastname: Oliveira
authors.affiliation: Internal Medicine Department, Unidade de Famalicão, Centro Hospitalar do Médio Ave. Rua Cupertino de Miranda, 4761-917 Vila Nova de Famalicão, Portugal. Electronic address: saracp86@gmail.com.
authors.forename: Sara
authors.initials: S
authors.lastname: Pereira
authors.affiliation: Internal Medicine Department, Unidade de Famalicão, Centro Hospitalar do Médio Ave. Rua Cupertino de Miranda, 4761-917 Vila Nova de Famalicão, Portugal. Electronic address: joanabarros17@gmail.com.
authors.forename: Joana
authors.initials: J
authors.lastname: Barros
authors.affiliation: Neurology Department, Hospital de Braga. Sete Fontes, São Victor, 4710-243 Braga, Portugal. Electronic address: ccarinamachado@gmail.com.
authors.forename: Célia
authors.initials: C
authors.lastname: Machado
authors.affiliation: Neuroradiology Department, Hospital de Braga. Sete Fontes, São Victor, 4710-243 Braga, Portugal. Electronic address: josemvamorim@gmail.com.
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Amorim
authors.affiliation: Neurology Department, Hospital de Braga. Sete Fontes, São Victor, 4710-243 Braga, Portugal. Electronic address: filipasantos@hotmail.com.
authors.forename: Ana Filipa
authors.initials: AF
authors.lastname: Santos
authors.affiliation: Neuroradiology Department, Centro Hospitalar de Vila Nova de Gaia. R. Dr. Francisco Sá Carneiro, 4400-129 Vila Nova de Gaia, Portugal. Electronic address: mqribeiro@gmail.com.
authors.forename: Manuel
authors.initials: M
authors.lastname: Ribeiro
authors.affiliation: Neurology Department, Hospital de Braga. Sete Fontes, São Victor, 4710-243 Braga, Portugal. Electronic address: carla.m.c.ferreira@gmail.com.
authors.forename: Carla
authors.initials: C
authors.lastname: Ferreira
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000799:Angioedema / Q000139:chemically induced* / Q000000981:diagnostic imaging; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects; D002545:Brain Ischemia / Q000150:complications; D016022:Case-Control Studies; D002540:Cerebral Cortex / Q000000981:diagnostic imaging*; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D010959:Tissue Plasminogen Activator / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D014059:Tongue / Q000473:pathology*
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Computed tomography; Ischemic stroke; Orolingual angioedema; Thrombolysis