Deans' stroke musings: Risk of Aneurysm Rupture After Thrombolysis in Patients With Acute Ischemic Stroke and Unruptured Intracranial Aneurysms

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Monday, October 11, 2021

Risk of Aneurysm Rupture After Thrombolysis in Patients With Acute Ischemic Stroke and Unruptured Intracranial Aneurysms

It is your responsibility not to have these problems until your stroke hospital has protocols in place to prevent these deaths and disability. YOUR RESPONSIBILITY! Obviously you can't expect your hospital to be competent in all types of strokes.

Risk of Aneurysm Rupture After Thrombolysis in Patients With Acute Ischemic Stroke and Unruptured Intracranial Aneurysms

View ORCID ProfileJyri Juhani Virta, Daniel Strbian, View ORCID ProfileJukka Putaala,

First published October 6, 2021, DOI: https://doi.org/10.1212/WNL.0000000000012771

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Abstract

Background and Objectives: Unruptured intracranial aneurysms (UIAs) are considered to be a relative contraindication for intravenous thrombolysis (IVT) in acute ischemic stroke (AIS). However, there is currently limited data on the risk of UIA rupture following 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: 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 AIS patients 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 an UIA rupture after IVT. Secondary outcomes were in-hospital symptomatic ICHs (ECASS-2 criteria, i.e., NIH Stroke Scale score increase of ≥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 AIS patients 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 following IVT. Three patients [2.3%, 95% confidence interval (CI) 0.6-5.8%] with large fusiform basilar artery UIAs suffered from a fatal rupture at 27 hours, 43 hours, and 19 days after IVT. All three were administered anticoagulation treatments following 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 AIS patients, respectively.

Discussion: IVT appears to be safe in AIS patients 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.