Department of Neurology, Cerebrovascular Center, Chonnam National University Hospital, Gwangju, Korea.
J Neuroimaging. 2012 Apr;22(2):197-200. doi: 10.1111/j.1552-6569.2010.00560.x. Epub 2010 Dec 9.
It is still controversial whether intravenous (IV) thrombolysis for acute ischemic stroke increases the risk of aneurysmal bleeding. We sought to find the risk for aneurysmal bleeding after IV thrombolysis in ischemic stroke patients with unruptured cerebral aneurysms.
We retrospectively analyzed consecutive patients with acute ischemic stroke who had received IVT between August 2006 and November 2009. Immediately after IV-tissue plasminogen activator (tPA) therapy (.9 mg/kg), patients underwent CT angiography, MR angiography. After that, all patients underwent follow-up angiography within 36 hours of the initiation of IV thrombolysis. Aneurysm-related hemorrhage was defined as a hemorrhage that was related to the aneurysm site.
A total of 201 patients were analyzed, and 8 (4.1%) had unruptured cerebral aneurysms. Of the 8 patients, 4 had aneurysms over 5 mm of the longest diameter. Three patients had intracerebral hemorrhage that developed at the site of infarction, which was unrelated to the aneurysms.
The results of this study suggest that IV thrombolysis might not increase the risk of aneurysmal bleeding in acute stroke patients with unruptured aneurysm < 10 mm in diameter. Further studies with a larger sample size are needed to confirm our result.
静脉溶栓治疗急性缺血性脑卒中是否会增加动脉瘤性出血的风险仍存在争议。我们旨在探讨伴有未破裂脑动脉瘤的急性缺血性脑卒中患者接受静脉溶栓治疗后发生动脉瘤性出血的风险。
我们回顾性分析了 2006 年 8 月至 2009 年 11 月期间接受静脉溶栓治疗的连续急性缺血性脑卒中患者。在静脉应用组织型纤溶酶原激活物（tPA）（0.9mg/kg）后即刻行 CT 血管造影、MR 血管造影。此后，所有患者均在开始静脉溶栓后 36 小时内行血管造影随访。将与动脉瘤部位相关的出血定义为与动脉瘤部位相关的出血。
共分析了 201 例患者，其中 8 例（4.1%）有未破裂脑动脉瘤。这 8 例患者中，4 例动脉瘤最长直径>5mm。3 例患者发生了与动脉瘤无关的梗死部位的脑出血。
本研究结果提示，对于直径<10mm 的未破裂动脉瘤的急性脑卒中患者，静脉溶栓可能不会增加动脉瘤性出血的风险。需要进一步开展更大样本量的研究来证实我们的结果。
