Cerebral Amyloid Angiopathy: A Hidden Risk for IV Thrombolysis?

Area of Science:

• Neurology
• Vascular Neurology
• Neurocritical Care

Background:

• Recombinant tissue plasminogen activator (t-PA) is the sole FDA-approved treatment for acute ischemic stroke.
• Cerebral microbleeds (CMBs) and cerebral amyloid angiopathy (CAA) are not absolute contraindications for t-PA, but data are limited.
• Intracerebral hemorrhage (ICH) is a known risk of t-PA therapy.

Purpose of the Study:

• To investigate the risk of severe intracerebral hemorrhage (sICH) following intravenous t-PA in patients with evidence of cerebral amyloid angiopathy (CAA).
• To characterize the pattern of ICH in patients with CAA receiving t-PA.
• To highlight the need for further research into thrombolysis risks in patients with CAA and/or CMBs.

Main Methods:

• Case report of two patients with fatal sICH after IV t-PA.
• Clinical and imaging review for evidence of CAA and CMBs.
• Analysis of ICH pattern and severity.

Main Results:

• Two cases of fatal sICH occurred in patients with confirmed CAA after IV t-PA administration.
• The observed ICH pattern was severe and catastrophic.
• Patients with CAA may be at increased risk for thrombolysis-associated sICH.

Conclusions:

• Cerebral amyloid angiopathy (CAA) may represent a risk factor for severe intracerebral hemorrhage following intravenous thrombolysis.
• The specific pattern of ICH in these cases warrants attention.
• Further research is crucial to understand and mitigate the risks of t-PA in patients with CAA and/or CMBs.