Thrombolysis-Related Hemorrhagic Infarction

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Abstract
Background and Purpose — The role of early and delayed recanalization after thrombolysis in the development of hemorrhagic transformation (HT) subtypes remains uncertain. We sought to explore the association between the timing of recanalization and HT risk in patients with proximal middle cerebral artery (MCA) occlusion treated with intravenous recombinant tissue plasminogen activator (rtPA) Methods — Thirty-two patients with acute stroke caused by proximal MCA occlusion treated with rtPA Results — Early and delayed recanalization was identified in 17 patients (53.1%) and 8 patients (25%), respectively. HT was detected in 14 patients (43.7%): 4 (12.5%) with hemorrhagic infarction (HI 1 ), 5 (15.6%) with HI 2 , 3 (9.3%) with parenchymal hematoma (PH 1 ), and 2 (6.8%) with PH 2 . Distribution of HT subtypes differed significantly ( P =0.025), depending on the time to artery reopening. Eight of 9 (89%), 1 of 5 (20%), and 8 of 18 (44.4%) with HI 1 -HI 2 , with PH 1 -PH 2 , and without HT, respectively, recanalized in 1 -HI 2 (11%), 4 with PH 1 -PH 2 (80%), and 3 without HT (16.6%). Neurological improvement was significantly ( P 1 -HI 2 (88%) than in those without HT (39%). Infarct volume was significantly ( P 1 -HI 2 (51.4±42 cm 3 ) than in patients with PH 1 -PH 2 (83.8±48 cm 3 ) and those without HT (98.4±84 cm 3 , P =0.021). The modified Rankin scale score was significantly lower in HI 1 -HI 2 compared with PH 1 -PH 2 patients (1.9±1.1 versus 4.6±1.2, P P =0.009.). Conclusions — Thrombolysis-related HI (HI 1 -HI 2 ) represents a marker of early successful recanalization, which leads to a reduced infarct size and improved clinical outcome.