Abstract TMP1: International Multicenter Study Demonstrating Safety of Intravenous Thrombolysis in Acute Ischemic Stroke Patients Harboring Unruptured Intracranial Aneurysms

Abstract

Objective: We sought to determine the safety of intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients harboring unruptured intracranial aneurysm (UIA) in a prospective, multi-center study. Methods: We prospectively analyzed data from consecutive AIS treated with IVT during a 4-year period at four tertiary-care stroke centers. All patients routinely underwent CT or MR angiography during hospitalization. The presence of UIA was documented on the basis of neuroradiology reports. Symptomatic intracranial hemorrhage (sICH) was defined as imaging evidence of ICH combined with an increase in NIHSS-score of ≥4 points. Results: Our multicenter study evaluated a total of 1398 AIS patients treated with IVT with available neurovascular imaging data. The presence of concomitant UIAs was identified in 42 cases (3.0%, 95%CI by adjusted Wald method: 2.2%-4.1%) harboring a total of 48 IAs. Four of the forty-two (8%) AIS patients had multiple aneurysms. The mean maximum diameter of UIA was 4.3±2.7mm ranging between 2-15 mm. Nearly all UIA were saccular (45/48, 94%) and the majority were located in the anterior circulation (29/48; 61%). The maximum diameter was ≥7mm and ≥10mm in 6 (12.5%) and 3 (6.3%) cases respectively. The rates of symptomatic and asymptomatic ICH were 2.4% (95%CI by adjusted Wald method: 0%-12.6%) and 7.1% (95%CI by adjusted Wald method: 1.8%-19.7%) respectively. The single sICH reported in our multi-center study was not caused by aneurysmal rupture, since the incidental aneurysm was located in the posterior communicating artery in the hemisphere that was contralateral to the sICH. The rates of in-hospital mortality and favorable functional outcome at hospital discharge (defined as modified Rankin Scale score of 0-1) were 2.4% (95%CI by adjusted Wald method: 0%-12.6%) and 50.0% (95%CI by adjusted Wald method: 35.5%-64.5%) respectively. Conclusions: Our prospectively collected multi-center data indicate the potential safety of IVT in AIS patients with UIA.