Cerebral aneurysms may not complicate stroke thrombolysis
MedWire News: The presence of an unruptured cerebral aneurysm does not appear to increase patients' risk for intracranial hemorrhage on receipt of intravenous (iv) tissue plasminogen activator (tPA) to treat acute stroke, say US researchers.
"The presence of an unruptured cerebral aneurysm is considered by many an exclusion criterion for the administration of IV tPA, although it is unclear whether IV thrombolysis increases the likelihood of aneurysm rupture," say Nancy Edwards (University of California San Francisco) and team.
They add that "the exclusion of this particular patient population is not trivial," with nearly one in 10 patients in their study found to have an unruptured aneurysm.
The study included 236 patients who were treated with iv tPA for acute ischemic stroke. Of these, 22 had unruptured cerebral aneurysms identified on pretreatment computed tomography or magnetic resonance imaging angiograms, with two patients having multiple aneurysms.
After thrombolysis, brain imaging revealed new intracranial hemorrhage in 14% of the patients with aneurysms and 19% of those without. No patient with an aneurysm had symptomatic intracranial hemorrhage, compared with 5% of those without.
Subarachnoid hemorrhage occurred at similar rates regardless of the presence of aneurysms, in 5% and 6% of the groups with and without aneurysms, respectively.
The three patients with aneurysms who developed intracerebral hemorrhage did so within the area of the infarction; this was contralateral to the aneurysm in two patients. One of these patients also developed subarachnoid hemorrhage, which was "of minimal extent" and associated with a parenchymal hemorrhage.
"Our analysis suggests that IV tPA is safe to administer in patients with pre-existing cerebral aneurysms, because the rate of aneurysm rupture and symptomatic intracranial hemorrhage is low," the team concludes in the journal Stroke.
"Indeed, the rate of symptomatic intracranial hemorrhage is comparable to the rate observed with IV tPA administration in general."
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By Eleanor McDermid