RT Journal Article
SR Electronic
T1 Risk of Aneurysm Rupture After Thrombolysis in Patients With Acute Ischemic Stroke and Unruptured Intracranial Aneurysms
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP e1790
OP e1798
DO 10.1212/WNL.0000000000012771
VO 97
IS 18
A1 Virta, Jyri Juhani
A1 Strbian, Daniel
A1 Putaala, Jukka
A1 Korja, Miikka
YR 2021
UL http://n.neurology.org/content/97/18/e1790.abstract
AB Background and Objectives Unruptured intracranial aneurysms (UIAs) are considered to be a relative contraindication for IV thrombolysis (IVT) in acute ischemic stroke (AIS). Currently, however, data are limited on the risk of UIA rupture after IVT. Our objective was to assess whether IVT for AIS can lead to a UIA rupture and intracranial hemorrhages (ICHs) in patients with unruptured UIAs.Methods This was a prospective cohort study of consecutive patients treated in a comprehensive stroke center between 2005 and 2019. We assessed radiology reports and records at the Finnish Care Register for Health Care to identify patients with UIAs among all patients with AIS treated with IVT at the center. We analyzed patient angiograms for aneurysm characteristics and other brain imaging studies for ICHs after IVT. The main outcome was in-hospital ICHs attributable to a UIA rupture after IVT. Secondary outcomes were in-hospital symptomatic ICHs (European-Australian Cooperative Acute Stroke Study [ECASS-2] criteria, i.e., NIH Stroke Scale score increase ≥4 points) and any in-hospital ICHs.Results A total of 3,953 patients were treated with IVT during the 15-year study period. One hundred thirty-two (3.3%) of the 3,953 patients with AIS had a total of 155 UIAs (141 saccular and 14 fusiform). The mean diameter of UIAs was 4.7 ± 3.8 mm, with 18.7% being ≥7 mm and 9.7% ≥10 mm in diameter. None of the 141 saccular UIAs ruptured after IVT. Three patients (2.3%, 95% confidence interval [CI] 0.6%–5.8%) with large fusiform basilar artery UIAs had a fatal rupture at 27 hours, 43 hours, and 19 days after IVT. All 3 were administered anticoagulation treatments after IVT, and anticoagulation took effect during the UIA rupture. Any ICHs and symptomatic ICHs were detected in 18.9% (95% CI 12.9%–26.2%) and 8.3% (95% CI 4.4%–13.8%) of all patients with AIS, respectively.Discussion IVT appears to be safe in patients with AIS with saccular UIAs, including larges UIAs (≥10 mm). Anticoagulation after AIS in patients with large fusiform posterior circulation UIAs may increase the risk of aneurysm rupture.AIS=acute ischemic stroke; CI=confidence interval; DS=digital subtraction; ICD-10=International Classification of Diseases, 10th revision; ICH=intracranial hemorrhage; IVT=IV thrombolysis; MR=magnetic resonance; NIHSS=NIH Stroke Scale; SAH=subarachnoid hemorrhage; UIA=unruptured intracranial aneurysm