Postthrombolysis blood pressure elevation is associated with hemorrhagic transformation

Area of Science:

• Neurology
• Radiology
• Cardiology

Background:

• Hemorrhagic transformation (HT) is a complication of ischemic stroke thrombolysis.
• Reliable predictors for HT following thrombolysis remain unidentified.
• Tissue plasminogen activator (t-PA) is a common thrombolytic agent.

Purpose of the Study:

• To identify reliable predictors of hemorrhagic transformation (HT) after stroke thrombolysis.
• To investigate the association between acute diffusion-weighted imaging (DWI) lesion volumes, blood pressure, and HT.
• To test the hypothesis that larger DWI lesion volumes and higher blood pressures correlate with HT.

Main Methods:

• Analysis of hemorrhage in a randomized trial comparing t-PA versus placebo in ischemic stroke patients.
• Hemorrhage assessment using susceptibility-weighted imaging (SWI) 2-5 days post-treatment in 97 patients.
• Classification of hemorrhage as petechial hemorrhagic infarction (HI) or parenchymal hematoma (PH).

Main Results:

• Parenchymal hematoma (PH) was more frequent in t-PA treated patients (11/49) than placebo (4/48).
• Patients with PH exhibited significantly larger acute diffusion-weighted imaging (DWI) lesion volumes (63.1 mL) compared to those without HT (27.6 mL).
• Higher weighted average systolic blood pressure (SBP) 24 hours post-treatment predicted PH (159.4 mmHg vs. 143.1 mmHg).

Conclusions:

• Pretreatment DWI lesion volume and post-thrombolysis blood pressure are significant predictors of HT.
• Consideration for excluding patients with very large baseline DWI volumes from t-PA therapy is advised.
• More stringent blood pressure control following stroke thrombolysis is recommended to mitigate HT risk.