Abstract W P69: Remote Intracerebral Hemorrhage After Intravenous Thrombolysis in Patients With Ischemic Stroke: An Uncommon Complication With an Unfavourable Outcome

Background and purpose: Few studies have examined Remote parenchymal hemorrhage (PHr) after intravenous thrombolysis (IV-tPA). The aim of this study was to determine frequency, risk factors, associated clinical and radiological features, and prognosis in patients with PHr. Methods: This is a multicentre (n=9 hospitals) study of consecutive patients included in the SONIIA registry- monitors quality of reperfusion therapies in Catalonia-(January 2011 - August 2013). All patients were treated with IV-tPA according to the SITS-MOST criteria and had a follow-up CT within the first 36 hours. PHr, solitary or multiple (≥2), was defined as any hemorrhage detected by CT in regions without visible ischemic damage. Variables collected: Demographics; Vascular risk factors; NIHSS (admission and at 24 hours); Etiology; Previous treatments; Hypertensive episodes (≥185/105mmHg) and hyperglycemia (≥140mg/dl) during treatment and within the first 24 hours; Functional outcome (favourable when Rankin scale ≤2) and mortality at 3 months. We reviewed neuroimaging of PHr and PH, and we considered symptomatic PHr when NIHSS increased ≥4 points. Bivariate and multivariate analyses compared patients with any PHr, pure PHr (PHr without associated PH) with those without PHr/PH. Results: We studied 992 patients (age 73.7 ± 13.4 years, 52.9% of them were men). We observed 34 (3.4%) patients with PHr and 26 (2.6%) of them were pure PHr, 75 (7.5%) PH and 883 (89%) without PHr/PH. PHr distribution: 11 (32.3%) of PHr were lobar, 7 (20.5%) deep, 3 (8.8%) brainstem/cerebellum, 5 (14.7 %) multiple and 8 (23.5%) associated to a PH. PHr was symptomatic in 17 (50%) cases. We found no significant differences between groups in demographics, frequency of traditional vascular risk factors, previous treatments, baseline NIHSS and etiology. However, hypertensive episodes (p=0.031) and hyperglycemia (p=0.012) during IV-tPA were independent predictors of pure PHr. Both PHr and pure PHr had worse neurological status at 24 hours (both p<0.001), worse functional outcome (p=0.003 and p=0.007) and higher mortality at 3 months (p=0.014 and p= 0.023). Conclusions: In conclusion, PHr was observed in 3.4% of patients and it was associated with a worse functional outcome and higher mortality at 3 months.