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Unruptured intracranial aneurysm (UIA) is considered to be a relative contraindication for acute ischemic stroke (AIS) intravenous thrombolysis (IVT)
.
Due to the limited data on the risk of UIA rupture after IVT
.
In order to evaluate whether IVT treatment of AIS can cause UIA rupture and intracranial hemorrhage (ICH) in patients with unruptured UIA, Jyri Virta, MD, from the Department of Neurology, University of Helsinki, Finland, conducted a study.
Patients with acute ischemic stroke with larger cystic unruptured UIAs appear to be relatively safe
.
Yimaitong compiles and organizes, please do not reprint without authorization
.
Research Introduction The researchers conducted a prospective cohort study of patients who received continuous treatment at a comprehensive stroke center from 2005 to 2019, and evaluated the radiology reports and records of the Finnish Healthcare Registry to determine who received IVT treatment at the stroke center UIA patients among all AIS patients
.
The researchers also analyzed the aneurysm characteristics of the patient's angiography and other brain imaging studies of ICH after IVT
.
The main outcome is ICH in the hospital caused by UIA rupture after IVT
.
Secondary outcomes were symptomatic ICH in the hospital (ECASS-2 criteria, that is, NIH stroke scale score increased by ≥ 4 points) and any in-hospital ICH
.
Main findings: ➤During the 15-year study period, a total of 3,953 patients received IVT treatment
.
Among them, 132 (3.
3%) patients had 155 UIAs (141 cystic and 14 fusiform)
.
The average diameter of UIAs is 4.
7±3.
8mm, of which 18.
7% have a measured diameter of ≥7mm and 9.
7% have a measured diameter of ≥10mm
.
141 cystic UIAs did not rupture after IVT
.
➤3 patients (2.
3%) with UIAs of the great fusiform basilar artery had fatal rupture at 27 hours, 43 hours, and 19 days after IVT
.
All 3 patients received anticoagulation therapy after IVT, and anticoagulation therapy took effect during UIA rupture
.
➤In the entire cohort, ICH and symptomatic ICH were detected in 18.
9% and 8.
3% of patients, respectively
.
Conclusion IVT seems to be safe in AIS patients with cystic UIA (including larger UIA (≥10mm))
.
However, for patients with large fusiform posterior circulation UIA, post-AIS anticoagulation may increase the risk of aneurysm rupture
.
Yimaitong compiled from: Virta, JJ, et al.
, Risk of Aneurysm Rupture After Thrombolysis in Patients With Acute Ischemic Stroke and Unruptured Intracranial Aneurysms.
Neurology, 2021: p.
10.
1212/WNL.
0000000000012771.
.
Due to the limited data on the risk of UIA rupture after IVT
.
In order to evaluate whether IVT treatment of AIS can cause UIA rupture and intracranial hemorrhage (ICH) in patients with unruptured UIA, Jyri Virta, MD, from the Department of Neurology, University of Helsinki, Finland, conducted a study.
Patients with acute ischemic stroke with larger cystic unruptured UIAs appear to be relatively safe
.
Yimaitong compiles and organizes, please do not reprint without authorization
.
Research Introduction The researchers conducted a prospective cohort study of patients who received continuous treatment at a comprehensive stroke center from 2005 to 2019, and evaluated the radiology reports and records of the Finnish Healthcare Registry to determine who received IVT treatment at the stroke center UIA patients among all AIS patients
.
The researchers also analyzed the aneurysm characteristics of the patient's angiography and other brain imaging studies of ICH after IVT
.
The main outcome is ICH in the hospital caused by UIA rupture after IVT
.
Secondary outcomes were symptomatic ICH in the hospital (ECASS-2 criteria, that is, NIH stroke scale score increased by ≥ 4 points) and any in-hospital ICH
.
Main findings: ➤During the 15-year study period, a total of 3,953 patients received IVT treatment
.
Among them, 132 (3.
3%) patients had 155 UIAs (141 cystic and 14 fusiform)
.
The average diameter of UIAs is 4.
7±3.
8mm, of which 18.
7% have a measured diameter of ≥7mm and 9.
7% have a measured diameter of ≥10mm
.
141 cystic UIAs did not rupture after IVT
.
➤3 patients (2.
3%) with UIAs of the great fusiform basilar artery had fatal rupture at 27 hours, 43 hours, and 19 days after IVT
.
All 3 patients received anticoagulation therapy after IVT, and anticoagulation therapy took effect during UIA rupture
.
➤In the entire cohort, ICH and symptomatic ICH were detected in 18.
9% and 8.
3% of patients, respectively
.
Conclusion IVT seems to be safe in AIS patients with cystic UIA (including larger UIA (≥10mm))
.
However, for patients with large fusiform posterior circulation UIA, post-AIS anticoagulation may increase the risk of aneurysm rupture
.
Yimaitong compiled from: Virta, JJ, et al.
, Risk of Aneurysm Rupture After Thrombolysis in Patients With Acute Ischemic Stroke and Unruptured Intracranial Aneurysms.
Neurology, 2021: p.
10.
1212/WNL.
0000000000012771.
