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Intravenous thrombolysis in the presence of unruptured intracranial aneurysm: safety, case report and literature review
EANS Academy. Beneš Jr V. 09/25/19; 275387; EP01001
Vladimir Beneš Jr
Vladimir Beneš Jr

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Introduction: Intravenous thrombolysis is a proven treatment of acute ischemic stroke. Its complications include intracranial hemorrhage. The presence of an unruptured aneurysm (UIA) can be considered a relative contraindication. The purpose of this study is to assess prevalence of UIAs in patients treated with thrombolysis; assess safety of intravenous thrombolysis in the presence of an UIA; and report a case of fatal aneurysm rupture and analyze similar patients from the literature.
Patients and methods: Retrospective analysis of prospectively collected data of patients undergoing thrombolytic treatment for stroke during 2016-2017. The patients were divided into two groups according to the presence of an UIA (UIA+ and UIA-).
Results: During the study period 294 patients received thrombolytic treatment for stroke, 13 patients harbored an UIA (prevalence 4,4%). There was no significant difference in basic demographic data between the two groups. There was one fatal aneurysm rupture in the UIA+ group, however overall rate of intracranial hemorrhage was not significantly different (7,7% UIA+ and 7,5% UIA-). The rate of favorable outcome at 3 moths was not significantly different (53,8% UIA+ and 52,8% UIA-). Further 8 patients suffering aneurysm rupture after thrombolysis were identified in the literature.
Conclusions: Presence of an aneurysm in patients undergoing thrombolytic treatment does not seem to bear negative impact on outcome and should not be considered a contraindication. Given higher aneurysm prevalence in stroke patients and very high rate of disastrous outcome following rupture after thrombolysis, we call for detailed evaluation of vessel imaging and exclusion of recent sentinel bleeding when an aneurysm is diagnosed.
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