Predictors for Intracranial Hemorrhage Following Intravenous Thrombolysis in Posterior Circulation Stroke.
Tomáš DorňákMichal KrálZuzana SedláčkováDaniel ŠaňákEva ČechákováPetra DivišováJana ZapletalováPetr KaňovskýPublished in: Translational stroke research (2018)
Intravenous thrombolysis (IVT) is a standard treatment for anterior (ACS) and posterior circulation stroke (PCS). However, due to the low occurrence of PCS and of intracranial hemorrhage (ICH) in PCS, the knowledge about ICH predictors following IVT in PCS is sparse. Our aim was to identify predictors for ICH following IVT in PCS. The set consisted of 1281 consecutive ischemic stroke (IS) patients treated with IVT, out of which 158 (103 males; mean age 65.6 ± 12.3 years) had PCS. Collected data include baseline characteristics, common stroke risk factors, pre-medication, stroke severity, admission blood glucose level, blood pressure and treatment with intravenous antihypertensive therapy before and during IVT, occlusion of arteries, recanalization rate, time to treatment, and clinical outcome at day 90. Overall, 11 (7%) patients had ICH. Atrial fibrillation (p = 0.004), neurological deficit at time of treatment in the National Institutes of Health Stroke Scale (p = 0.016), decreased level of consciousness (p = 0.003), occlusion of basilar artery (p = 0.007), occlusion of PCA (p = 0.001), and additional endovascular therapy (p = 0.001) were identified by logistic regression analysis as significant predictors for ICH in PCS. Patients with ischemic lesion in the brainstem, occlusion of vertebral artery, or absence of basilar and posterior cerebral artery occlusion might be considered for treatment with IVT even in borderline cases. Those patients seem to have less frequently favorable outcomes without an increase in ICH rate. Time to IVT in PCS seems not to influence ICH risk or chances for favorable outcomes as significantly as it does in ACS.
Keyphrases
- atrial fibrillation
- blood pressure
- blood glucose
- healthcare
- risk factors
- emergency department
- combination therapy
- ejection fraction
- public health
- acute coronary syndrome
- stem cells
- high dose
- low dose
- metabolic syndrome
- pulmonary embolism
- prognostic factors
- left atrial
- mental health
- bone mineral density
- oxidative stress
- postmenopausal women
- insulin resistance
- left ventricular
- body composition
- blood flow
- percutaneous coronary intervention
- cerebral ischemia
- electronic health record
- bone marrow
- chronic kidney disease
- mesenchymal stem cells
- smoking cessation
- replacement therapy
- hypertensive patients
- optic nerve
- artificial intelligence
- patient reported
- deep learning