• Nitin Goyal, Georgios Tsivgoulis, Ramin Zand, Vijay K Sharma, Kristian Barlinn, Shailesh Male, Aristeidis H Katsanos, Ulf Bodechtel, Sulaiman Iftikhar, Adam Arthur, Lucas Elijovich, Anne W Alexandrov, and Andrei V Alexandrov.
• From the Department of Neurology (N.G., G.T., R.Z., S.M., S.I., L.E., A.W.A., A.V.A.), The University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K.), "Attikon" Hospital, School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T.), Department of Neurology, St. Anne's University Hospital in Brno, Czech Republic; Department of Neurology (V.K.S.), National University Hospital, Singapore; Department of Neurology (K.B., U.B.), Carl Gustav Carus University Hospital, Dresden University Stroke Center, Germany; Department of Neurosurgery (A.A., L.E.), The University of Tennessee Health Science Center, Memphis; and Australian Catholic University (A.W.A.), School of Nursing, Sydney, Australia.
• Neurology. 2015 Oct 27; 85 (17): 1452-8.

ObjectiveWe sought to determine the safety of IV thrombolysis (IVT) in acute ischemic stroke (AIS) patients harboring unruptured intracranial aneurysm (UIA) in a multicenter study and a comprehensive meta-analysis of available case series.MethodsWe analyzed prospectively collected data from consecutive AIS patients treated with IVT during a 4-year period at 4 tertiary-care stroke centers. All patients routinely underwent CT or magnetic resonance angiography during hospitalization. The presence of UIA was documented on the basis of neuroradiology reports. Symptomatic intracranial hemorrhage (sICH) was defined as imaging evidence of ICH combined with an increase in NIH Stroke Scale score of ≥4 points. A systematic meta-analysis of case series reporting safety of IVT in AIS with concomitant UIA was conducted according to PRISMA recommendations.ResultsAmong 1,398 AIS patients treated with IVT, we identified 42 cases (3.0%) harboring a total of 48 UIAs. The rates of symptomatic and asymptomatic ICH were 2.4% (95% confidence interval [CI] by adjusted Wald method: 0%-12.6%) and 7.1% (95% CI: 1.8%-19.7%), respectively. A total of 5 case series met our inclusion criteria for meta-analysis, and the pooled rate of sICH among 120 IVT-treated AIS patients harboring UIA was 6.7% (95% CI: 3.1%-13.7%). In the overall analysis of 5 case-series studies, the risk ratio of sICH did not differ between AIS patients with and without UIA (risk ratio = 1.60; 95% CI: 0.54-4.77; p = 0.40) with no evidence of heterogeneity across included studies (I(2) = 22% and p = 0.27 for Cochran Q test).ConclusionsOur prospectively collected multicenter data, coupled with the findings of the meta-analysis, indicate the potential safety of IVT in AIS patients with UIA.© 2015 American Academy of Neurology.

31 keywords...

hide…