Stroke. 2012; 43: 412-416
The Safety of Intravenous Thrombolysis for Ischemic Stroke in Patients With Pre-Existing Cerebral Aneurysms
A Case Series and Review of the Literature
- Nancy J. Edwards, MD;
- Hooman Kamel, MD;
- S. Andrew Josephson, MD
+ Author
Affiliations
- Correspondence to Nancy J. Edwards, MD, University of California San Francisco, Neurovascular Service, 505 Parnassus Avenue, Box 0114, San Francisco, CA 94143-0114. E-mail nancy.edwards@ucsfmedctr.org
Abstract
Background and Purpose—Unruptured cerebral aneurysms
are currently considered a contraindication to intravenous tissue-type
plasminogen activator for acute ischemic stroke. This is due to a theoretical
increase in the risk of hemorrhage from aneurysm rupture, although it is unknown
whether this risk is a significant one. We sought to determine the safety of
intravenous tissue-type plasminogen activator administration in a cohort of
patients with pre-existing aneurysms.
Methods—We reviewed the medical records of patients
treated for acute ischemic stroke with intravenous tissue-type plasminogen
activator during an 11-year period at 2 academic medical centers. We identified
a subset of patients with unruptured cerebral aneurysms present on
prethrombolysis vascular imaging. Our outcomes of interest were any intracranial
hemorrhage, symptomatic intracranial hemorrhage, and subarachnoid hemorrhage.
Fisher exact test was used to compare the rates of hemorrhage among patients
with and without aneurysms.
Results—We identified 236 eligible patients, of whom
22 had unruptured cerebral aneurysms. The rate of intracranial hemorrhage among
patients with aneurysms (14%; 95% CI, 3%–35%) did not significantly differ from
the rate among patients without aneurysms (19%; 95% CI, 14%–25%). None of the
patients with aneurysms developed symptomatic intracranial hemorrhage (0%; 95%
CI, 0%–15%) compared with 10 of 214 patients without aneurysms (5%; 95% CI,
2%–8%). Similar proportions of patients developed subarachnoid hemorrhage (5%;
95% CI, 0%–23% versus 6%; 95% CI, 3%–10%).
Conclusions—Our findings suggest that intravenous
tissue-type plasminogen activator for acute ischemic stroke is safe to
administer in patients with pre-existing cerebral aneurysms because the risk of
aneurysm rupture and symptomatic intracranial hemorrhage is low.
Disclaimer--
Please note these are people who were incidentally found to have aneurysms on screening. There is no guideline to say that managing patients with tpa is safe or valid.
