Members of the MR Stroke Study Group are listed in the Appendix on page xx.
Risk for symptomatic intracerebral hemorrhage after thrombolysis assessed by diffusion-weighted magnetic resonance imaging†
Version of Record online: 19 SEP 2007
Copyright © 2007 American Neurological Association
Annals of Neurology
Volume 63, Issue 1, pages 52–60, January 2008
How to Cite
Singer, O. C., Humpich, M. C., Fiehler, J., Albers, G. W., Lansberg, M. G., Kastrup, A., Rovira, A., Liebeskind, D. S., Gass, A., Rosso, C., Derex, L., Kim, J. S. and Neumann-Haefelin, T. (2008), Risk for symptomatic intracerebral hemorrhage after thrombolysis assessed by diffusion-weighted magnetic resonance imaging. Ann Neurol., 63: 52–60. doi: 10.1002/ana.21222
- Issue online: 29 JAN 2008
- Version of Record online: 19 SEP 2007
- Manuscript Revised: 31 JUL 2007
- Manuscript Accepted: 31 JUL 2007
- Manuscript Received: 26 APR 2007
- German centers—Bundesministerium für Bildung und Wissenschaft within the Kompetenznetzwerk Schlaganfall (Stroke Imaging Net
- Stanford—NIH (National Institute for Neurological Disorders and Stroke. Grant Numbers: RO1 NS39325, K23 NS051372
- Los Angeles—NIH (National Institutes for Neurological Disorders and Stroke. Grant Number: 5K23NS054084 5P50NS044378-03
- Paris—Programme Hospital de Recherche Clinique (PHRC). Grant Number: AOM 03 008 EVAL-USINV
- Ministry of Science and Technology of Korea. Grant Number: M103KV010010 06K2201 01010
The risk for symptomatic intracerebral hemorrhage (sICH) associated with thrombolytic treatment has not been evaluated in large studies using diffusion-weighted imaging (DWI). Here, we investigated the relation between pretreatment DWI lesion size and the risk for sICH after thrombolysis.
In this retrospective multicenter study, prospectively collected data from 645 patients with anterior circulation stroke treated with intravenous or intraarterial thrombolysis within 6 hours (<3 hours: n = 320) after symptom onset were pooled. Patients were categorized according to the pretreatment DWI lesion size into three prespecified groups: small (≤10ml; n = 218), moderate (10–100ml; n = 371), and large (>100ml; n = 56) DWI lesions.
In total, 44 (6.8%) patients experienced development of sICH. The sICH rate was significantly different between subgroups: 2.8, 7.8, and 16.1% in patients with small, moderate, and large DWI lesions, respectively (p < 0.05). This translates to a 5.8 (2.8)-fold greater sICH risk for patients with large DWI lesions as compared with patients with small (or moderate) DWI lesions. The results were similar in the large subgroup (n = 536) of patients treated with intravenous tissue plasminogen activator. DWI lesion size remained an independent risk factor when including National Institutes of Health Stroke Scale, age, time to thrombolysis, and leukoariosis in a logistic regression analysis.
This multicenter study provides estimates of sICH risk in potential candidates for thrombolysis. The sICH risk increases gradually with increasing DWI lesion size, indicating that the potential benefit of therapy needs to be balanced carefully against the risk for sICH, especially in patients with large DWI lesions. Ann Neurol 2007