Intracranial Hemorrhage in Patients With Stroke After Endovascular Treatment With or Without IV Alteplase

What is the profile of intracranial hemorrhage (ICH) in patients with stroke after endovascular treatment with or without intravenous alteplase, and what is the association with patient outcomes?In this individual participant data meta-analysis (n = 2313 participants) of 6 randomized clinical trials, intravenous thrombolysis before thrombectomy was associated with a significant increase of any ICH (36% vs 32%) and parenchymal hematoma (7% vs 5%) vs thrombectomy alone. Asymptomatic and symptomatic ICH were both associated with worse functional outcomes.Intravenous thrombolysis before thrombectomy may modestly increase the risk of ICH (notably, any parenchymal hematoma), but this effect may be offset by its benefit in reperfusion.

Corresponding Authors: Pengfei Yang, MD (p.yang@vip.163.com), and Jianmin Liu, MD (liu118@vip.163.com), Neurovascular Center, Naval Medical University Changhai Hospital, 168 Changhai Road, Shanghai, China.

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