Remote or Extraischemic Intracerebral Hemorrhage—An Uncommon Complication of Stroke Thrombolysis

Abstract

Background: Intracerebral hemorrhage (ICH) following treatment with intravenous thrombolysis (IV-tPA) for ischemic stroke can occur in local relation to the infarct, as well as in brain areas remote from infarcted tissue. We aimed to describe risk factors, three month mortality and functional outcome in patients with the poorly understood complication of remote ICH, as well as local ICH. Methods: 43494 patients treated with IV-tPA, with complete imaging data, were enrolled in the SITS International Stroke Thrombolysis Register during 2002-2011. Baseline data were compared between 970 patients (2.2%) with remote parenchymal hemorrhage (PHr), 2325 (5.3%) with local PH, 438 (1.0%) with both PH and PHr, and 39761 (91.4%) without PH or PHr. Independent risk factors for all hemorrhage types were obtained by multivariate logistic regression. Results: Previous stroke (p=0.023) and higher age (p<0.001) were independently associated with PHr, but not with PH. Atrial fibrillation, CT hyperdense cerebral artery sign and elevated blood glucose were associated with PH, but not PHr. Female sex had a stronger association with PHr than with PH. Functional independence at 3 months was more common in PHr than PH (34% vs 24%, p0 <0.001). Conclusions: Differences between risk factor profiles indicate an influence of prior vascular pathology in PHr, and acute large vessel occlusion in PH. Further research is needed on the impact of pre-existing cerebrovascular disease on complications of recanalization therapy in acute ischemic stroke. (Figure Presented).