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Risk for symptomatic intracerebral hemorrhage after thrombolysis assessed by diffusion‐weighted magnetic resonance imaging
Author(s) -
Singer Oliver C.,
Humpich Marek C.,
Fiehler Jens,
Albers Gregory W.,
Lansberg Maarten G.,
Kastrup Andiras,
Rovira Alex,
Liebeskind David S.,
Gass Achim,
Rosso Charlotte,
Derex Laurent,
Kim Jong S.,
NeumannHaefelin Tobias
Publication year - 2008
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.21222
Subject(s) - medicine , thrombolysis , intracerebral hemorrhage , lesion , magnetic resonance imaging , logistic regression , stroke (engine) , radiology , effective diffusion coefficient , diffusion mri , surgery , subarachnoid hemorrhage , mechanical engineering , myocardial infarction , engineering
Objective 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. Methods 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. Results 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. Interpretation 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