Abstract
BackgroundThe presence of an intracranial aneurysm is contraindicated to recombinant tissue plasminogen activator (r-tPA) treatment for acute ischemic stroke. However, it is difficult to exclude asymptomatic intracranial aneurysms by using conventional, noncontrast head computed tomography (CT), which is the only neuroimaging suggested before r-tPA. Recent case reports and series have shown that administering r-tPA to patients with a pre-existing aneurysm does not increase the bleeding risk. However, Asians are known to have a relatively higher bleeding risk, and little evidence is available regarding the risk of using r-tPA on Asian patients with intracranial aneurysms.MethodsMedical records from the Shuang Ho hospital stroke registration between July 2010 and December 2014 were retrospectively reviewed, and 144 patients received r-tPA. Unruptured intracranial aneurysms were detected using CT, or magnetic resonance or conventional angiography after r-tPA. The primary and secondary outcomes were the difference in overall intracranial hemorrhage (ICH) and symptomatic ICH after r-tPA. The differences were analyzed using Fisher’s exact or Mann–Whitney U tests, and p < 0.05 was defined as the statistical significance.ResultsA total of 144 patients were reviewed, and incidental unruptured intracranial aneurysms were found in 11 of them (7.6%). No significant difference was observed in baseline demographic data between the aneurysm and nonaneurysm groups. Among patients with an unruptured aneurysm, two had giant aneurysms (7.7 and 7.4 mm, respectively). The bleeding risk was not significant different between aneurysm group (2 out of 11, 18%) with nonaneurysm group (7 out of 133, 5.3%) (p = 0.14). None of the patients with an unruptured aneurysm had symptomatic ICH, whereas one patient without an aneurysm exhibited symptomatic ICH.ConclusionsThe presence of an unruptured intracranial aneurysm did not significantly increase the risk of overall and symptomatic ICH in Taiwanese patients after they received r-tPA.
Highlights
Intracranial hemorrhage (ICH) is an unfavorable and potentially fatal complication of thrombolytic therapy based on recombinant tissue plasminogen activator treatment (r-tPA) in patients with acute ischemic stroke [1, 2]
According to guidelines from the Stroke Council of the American Heart Association/American Stroke Association (AHA/ASA), serial exclusion criteria are set to avoid the administration of r-tPA in patients with a high risk of post-r-tPA ICH, such as those with uncontrolled high blood pressure, coagulopathy, and a history of ICH [3, 4]
Because the presence of an intracranial aneurysm is contraindicated to r-tPA, physicians struggle with the dilemma of performing either computed tomography (CT) or magnetic resonance (MR) angiography to exclude the possibility of intracranial aneurysms, or shortening the interval between the onset of stroke and the application of r-tPA but omitting this contraindication
Summary
The presence of an intracranial aneurysm is contraindicated to recombinant tissue plasminogen activator (r-tPA) treatment for acute ischemic stroke. It is difficult to exclude asymptomatic intracranial aneurysms by using conventional, noncontrast head computed tomography (CT), which is the only neuroimaging suggested before r-tPA. Recent case reports and series have shown that administering r-tPA to patients with a pre-existing aneurysm does not increase the bleeding risk. Asians are known to have a relatively higher bleeding risk, and little evidence is available regarding the risk of using r-tPA on Asian patients with intracranial aneurysms. Data Availability Statement: Data are from Shuang Ho Hospital. It is allowed to use for academic purpose only after proof by TMU-JIRB. Data requests may be sent to Data Safety Managing Section, TMU-JIRB
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
