5-Year Analysis of Intravenous Thrombolysis Related Intracranial Hemorrhage

Introduction: The primary aim of this study is to examine the association between IV thrombolysis in patients with acute ischemic stroke and post-IVT intracranial hemorrhage. The secondary aim is to evaluate cerebral microbleed as an independent risk factor for post-IVT intracranial hemorrhage.

Method(s): Records from all patients presenting to the Queen Elizabeth Hospital Birmingham with acute ischemic stroke treated with IVT over a 5-year period were retrospectively reviewed. Demographics, medical, and imaging variables were evaluated. Gradient Echo MRI sequences were used to evaluate the number and location of CMBs. Statistical models were used to determine the relationship between CMBs and symptomatic hemorrhagic transformation.

Result(s): Of 434 consecutive patients, the number of patients with intra or extra axial bleeding following IVT was 43 (9.9%) confirmed on postthrombolysis CT brain. Of those, 79.5% had ICH, 18.2% had SAH, and 2.3% had SDH. Of patients with ICH, 30 (85.7%) patients had hemorrhagic transformation (HT).

Conclusion(s): The rate of post-IVT ICH is approximately 10%. Reliable risk assessment for probable CAA requires pre-existing MRI head prior to IVT treatment. This is a practical limitation of current practice.

Publication History

Article published online:
09 February 2023