Abstract W MP32: Is Acute Reperfusion Therapy Safe in Acute Ischemic Stroke Patients Who Harbor Unruptured Intracranial Aneurysm?

Abstract

BACKGROUND: Intracranial aneurysm was considered an exclusion criteria for intravenous(IV) thrombolysis in acute ischemic stroke in both NINDS and ECASS III studies, possibly due to a hypothetical increase in the risk of bleeding from the aneurysm rupture; however, there is limited data available on whether IV thrombolysis is unsafe for acute ischemic stroke patients with incidental brain aneurysms and to the best of our knowledge, no data is available on the safety of combination of IV and intra-arterial (IA) thrombolysis in those patients. AIM: To find out the safety of acute reperfusion therapy in acute ischemic stroke patients who harbor intracranial aneurysm. METHODS: We retrospectively reviewed the medical records and cerebrovascular images of all the patients treated with IV thrombolysis for acute ischemic stroke in our center from the beginning of 2006 till the end of April 2014. Those with evidence of unruptured intracranial aneurysm on cerebrovascular images prior to acute reperfusion therapy were identified. Post thrombolysis brain imaging were reviewed to evaluate for any symptomatic intraparenchymal or subarachnoid hemorrhage related or unrelated to the aneurysms. RESULTS: A total of 637 patients received IV thrombolysis in our center during a 9.3 years period. 33 (5.1%) were found to have at least one intracranial aneurysm. 24(72.7%) of those received only IV thrombolysis and 9 patients received combination of IV and IA thrombolysis. The size of the largest aneurysm was 9 mm (Range: 2 mm to 9 mm). No symptomatic intracranial hemorrhage occurred among the 24 patients receiving only IV thrombolysis. Out of those who received a combination of IV and IA thrombolysis, 1 developed symptomatic intraparenchymal hemorrhage with intraventricular extension in the location of acute infarct, distant to the aneurysm location. CONCLUSION: Our findings suggest that neither IV thrombolysis nor combination IV and IA thrombolysis increase the risk of aneurysmal hemorrhage in acute ischemic stroke patients who harbor unruptured intracranial aneurysms less than 10 mm in diameter. Their listing in exclusion criteria for IV thrombolysis should be reconsidered to assure appropriate use of acute reperfusion therapy in this group of patients.