Abstract T P62: The Presence of Cerebral Microhemorrhage is Not Associated With Hemorrhagic Conversion Following Post Thrombolysis for Acute Ischemic Stroke

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Introduction: Hemorrhagic conversion remains an unpredictable complication of thrombolysis for acute ischemic stroke. Cerebral microhemorrhages (CMH) have been associated with intracerebral hemorrhage (ICH) and may serve as a biomarker for hemorrhagic conversion of acute ischemic stroke treated with tissue plasminogen activator. We sort to determine the relationship of the presence of CMH and hemorrhagic conversion of acute ischemic stroke treated with intravenous thrombolysis. Method: Using our institutional stroke registry, we identified patients with acute ischemic stroke treated with intravenous tissue plasminogen activator between the period January 1, 2012 and December 31, 2012; whose workup included an MRI with gradient recovery echo (GRE) sequence performed within 12-24 hours of receiving thrombolysis. The presence and location of CMH were recorded and compared with the presence of post thrombolytic (ICH). Variables on patient demographics, clinical history (hypertension, diabetes mellitus, hyperlipidemia, atrial fibrillation, coronary artery disease, congestive heart failure, chronic renal insufficiency), NIHSS, LDL, HDL, HbA1c, total cholesterol and ejection fraction on transthoracic echocardiogram were collected and analyzed. Statistical analysis was done using fisher exact test for categorical variables and t-test for continuous variables. Result: 68 patients were identified and studied. Fifteen patients (23.5%) demonstrated CMH, while a total number of 45 CMH (37 lobar and 8 Non-lobar) was observed. Hemorrhagic conversion was more frequent in patients with CMH compared to patients without CMH; however, it was not statistically significant (26.7 % vs 9.4% p=0.0999). In addition, there was no difference in the frequency of parenchymal hematoma between the groups (20% vs 5.7% p=0.116). Of the clinical and laboratory variables recorded, only a history of atrial fibrillation was significantly different between the patients with and without CMH (0 vs 26.4% p=0.0289). Conclusion: The presence of CMH on GRE is not associated with an increased frequency of hemorrhagic conversion or presence of parenchymal hematoma following thrombolysis for acute ischemic stroke.