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Prevalence of MRI-defined recent silent ischemia and associated bleeding risk with thrombolysis

M Tisserand1, L Le Guennec, E Touzé

  • 1Department of Radiology, Université Paris Descartes, Centre de Psychiatrie et Neurosciences, INSERM UMR S894, Centre Hospitalier Sainte-Anne, Paris, France.

Neurology
|March 11, 2011
PubMed
Abstract

Insights

Recent silent ischemia (RSI) on pretreatment MRI was found in 18.3% of acute stroke patients receiving IV thrombolysis. Importantly, RSI did not increase the risk of bleeding complications, including symptomatic or asymptomatic hemorrhagic transformation.

Area of Science:

  • Neurology
  • Radiology
  • Cardiovascular Medicine

Background:

  • Recent silent ischemia (RSI) on pretreatment MRI in stroke patients undergoing thrombolysis requires risk assessment.
  • Exclusion from thrombolysis due to incidental MRI findings has significant patient consequences.

Purpose of the Study:

  • To clarify the frequency of RSI on pretreatment MRI in acute stroke patients.
  • To determine if RSI is associated with an increased risk of hemorrhagic transformation (HT) after IV thrombolysis.

Main Methods:

  • Retrospective analysis of 115 patients' pre-IV thrombolysis FLAIR/DWI MRI scans.
  • Identified MRI-defined RSI (RSI+) versus no RSI (RSI-).
  • Compared baseline characteristics and rates of symptomatic/asymptomatic HT between groups.

Main Results:

  • RSI was detected in 18.3% of patients.
  • No significant differences in baseline characteristics between RSI+ and RSI- groups.
  • No significant difference in the rates of any type of hemorrhagic transformation (symptomatic or asymptomatic) between groups.

Conclusions:

  • 18.3% of acute stroke patients treated with IV thrombolysis had pretreatment MRI evidence of RSI.
  • The presence of RSI was not associated with an elevated risk of hemorrhagic transformation.

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