Letter by Munoz Arrondo et al regarding article, "Iodinated contrast media and cerebral hemorrhage after intravenous thrombolysis".
نویسندگان
چکیده
BACKGROUND AND PURPOSE Iodinated contrast is increasingly used in CT perfusion or angiographic examinations in acute stroke. Increased risk of intracranial hemorrhage (ICH) complicating microcatheter contrast injections has recently been reported in the second Interventional Management of Stroke (IMS 2) trial with contrast toxicity potentially contributory. METHODS We reviewed clinical and radiological data on all patients treated with intravenous alteplase at a single center between May 2003 and November 2008. RESULTS Of 312 patients treated with intravenous alteplase, 69 (22.1%) received intravenous iodinated contrast in volumes between 50 and 150 mL. Incidence of symptomatic ICH defined as per European Cooperative Acute Stroke Study 2 was 16 of 312 (5.1%; 95% CI, 2.7% to 7.6%); among patients not given contrast, it was 12 of 243 (4.9%; 2.2% to 7.7%) compared with 4 of 69 (5.8%; 0.3% to 11.3%) in those given contrast. Incidence of symptomatic ICH defined as per Safe Implementation of Thrombolysis in Stroke-MOnitoring Study (SITS-MOST) criteria was 12 of 312 (3.9%; 1.7% to 6%), 9 of 243 (3.7%; 1.3% to 6%) among those not given contrast, and 3 of 69 (4.4%; 95% CI, -0.5% to 9.2%) among those given contrast. Patients with symptomatic ICH were older, had higher pretreatment National Institutes of Health Stroke Scale, and blood glucose than those without symptomatic ICH. In logistic regression analysis, pretreatment blood glucose was the only significant predictor of symptomatic ICH by either definition (OR, 1.23; 95% CI, 1.03 to 1.48 per mmol/L increment; P=0.024). Contrast administration or dose was not associated with symptomatic ICH. CONCLUSIONS Intravenous iodinated contrast in doses typically required for CT angiography and perfusion imaging was not associated with symptomatic intracranial hemorrhage in patients treated with alteplase.
منابع مشابه
Iodinated Contrast Media and Cerebral Hemorrhage After Intravenous Thrombolysis
Background and Purpose—Iodinated contrast is increasingly used in CT perfusion or angiographic examinations in acute stroke. Increased risk of intracranial hemorrhage (ICH) complicating microcatheter contrast injections has recently been reported in the second Interventional Management of Stroke (IMS 2) trial with contrast toxicity potentially contributory. Methods—We reviewed clinical and radi...
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Letter by Yang and Bai regarding article, "Safety of intravenous thrombolysis in stroke mimics: prospective 5-year study and comprehensive meta-analysis".
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BACKGROUND AND PURPOSE Patients with renal impairment (RI) have an increased risk of both thrombotic and hemorrhagic events. We aimed to clarify whether RI increases the risk of intracerebral hemorrhage (ICH) after intravenous thrombolysis with recombinant tissue plasminogen activator. METHODS Patients who received intravenous thrombolysis with recombinant tissue plasminogen activator within ...
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عنوان ژورنال:
- Stroke
دوره 42 8 شماره
صفحات -
تاریخ انتشار 2011