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Impact of Extraischemic Hemorrhage After Thrombolysis with Intravenous Recombinant Tissue Plasminogen Activator

Background: Thrombolysis is efficacious for acute ischemic stroke; however it might increase the risk of following hemorrhage. Generally, hemorrhage may occur within the ischemic region because of ischemiareperfusion injury. However, hemorrhage of extraischemic lesion called extraischemic hemorrhage (EH) may sometimes observed. The risks and outcome of EH have been still controversial. Therefore, this study aimed to reveal the clinical characteristics of EH in recent cases.

Methods: Acute ischemic stroke patients who were treated with intravenous recombinant tissue plasminogen activator administration within 4.5 hrs following onset were consecutively screened (n=112). All cases were classified into no-bleeding (NB), cerebral hemorrhage within infarct lesion (HI) and EH groups. The MRI findings, patient’s background and outcome were assessed between EH and other groups.

Results: Incidence rate of NB, HI and EH were 62.5%, 31.2% and 6.3%, respectively. There was no significant difference of patients’ background between EH and other groups. While, patients of EH group showed significantly higher frequency of microbleeds in subcortical region compared with NB group (p=0.01: 71.4% and 21.4%, respectively). Leukoaraiosis in deep white matter region was significantly severer in EH compared with NB group (p=0.03). Although neurologic severity at onset was the same among three groups, the outcome was significantly worse in EH group compared with other groups (p=0.04).

Conclusion: Our results confirmed that extraischemic hemorrhage after thrombolysis could cause worse outcome. Moreover, it was revealed the underlying small vessel disease, represented by microbleeds and leukoaraiosis in subcortical area, might be associated with extraischemic hemorrhage.


Takuro Endo, Taizen Nakase, Masahiro Sasaki and Tatsuya Ishikawa

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