Predictors of Hemorrhagic Transformation Following Intra-Arterial Thrombolysis

Abstract

18 Background: Hemorrhagic transformation is a major complication of intra-arterial (IA) thrombolytic therapy. Delineation of significant predictors of intracerebral hemorrhage (ICH) following thrombolysis would be useful to guide patient selection for IA treatment. Methods: Data were collected on consecutive patients with acute cerebral ischemia treated with IA thrombolysis over an 8 year period at UCLA Medical Center. Patients received either pure IA thrombolytics (tPA or urokinase) or combined intravenous/intra-arterial (IV/IA) tPA. Using univariate and multivariate analyses, 58 variables were examined as potential predictors of ICH. Results: A total of 89 patients were treated, 77 anterior circulation, 12 posterior circulation. Median baseline NIHSS score was 16. 26 patients received IA tPA only, 22 IV/IA tPA, and 41 IA urokinase only. Asymptomatic ICH occurred in 29 patients (33%), minor symptomatic ICH in 10 (11%), and major symptomatic ICH in 6 (7%). Of the 45 patients with M1 or M2 MCA occlusions treated with pure IA thrombolysis, 4 (9%) had major symptomatic ICH. There was no difference in the rate of any ICH with pure IA thrombolysis (39%) vs. combined IV/IA thrombolysis (41%). In pure IA cases, there was no difference in ICH rate between tPA and urokinase. 86% of patients with any ICH were dead or disabled (MRS > 2) at day 7 vs. 39% without ICH (p Conclusions: In this large series of patients treated with intra-arterial thrombolysis, higher NIHSS score, longer time to recanalization, and lower platelet count were independent predictors of hemorrhagic transformation. A model incorporating these variables identified patients who would develop ICH with 75% accuracy.