Anterior Communicating Artery Aneurysm Rupture After Intravenous Thrombolysis for Acute Middle Cerebral Artery Thromboembolism

Abstract

Screening to identify patients at risk for development of hemorrhagic complications from underlying structural vascular lesions before the use of IV rtPA with computed tomography angiography should be considered.

Intravenous Thrombolytic Therapy in Acute Stroke: Problems and Solutions

“…The AHA commission noted that the presence of aneurysms with a diameter less than 10 mm on CT angiography would not change the IV tPA decision and that larger aneurysms could not be assured of safety and more experience was needed (7). In the literature, aneurysmal rupture (mortal) after systemic tPA has been published in at least 3 non-stroke cases, one combined with heparin for AMI and a 100-mg dose (71,72,73). There is no such case report in the dose used for stroke.…”

Acute Ischaemic Stroke Treated with Intravenous Thrombolysis in a Patient with a Known Large Brainstem Cavernous Malformation - Case Report and Literature Review

“…73% of these aneurysms are located in the anterior circulation and 27% in the posterior circulation [5]. It is important to note that the bleeding usually associated with aneurysm rupture is subarachnoid haemorrhage [6].…”

Systemic thrombolysis in acute ischemic stroke patients with unruptured intracranial aneurysms

“…The former hypothesis was based on single case reports of AIS patients with concomitant undiagnosed UIA that developed sICH due to aneurysmal rupture as a complication of IVT. [5][6][7] However, small retrospective case series collecting data from a single [8][9][10][11] or 2 centers 12 have reported that sICH risk is not increased in AIS patients with coexisting UIA in comparison to those with absent intracranial aneurysms or vascular malformations. In view of former considerations, the aim of the present multicenter study was to determine the safety of IVT in AIS patients harboring UIAs.…”

“…After retrieving the fulltext version of the aforementioned 15 studies, 10 studies were excluded because they reported case reports of single patients or they reported case series of fewer than 5 AIS patients with UIA treated with IVT. [5][6][7][27][28][29][30][31][32][33] Characteristics of patients in excluded studies are available in table e-2. In the final presentation of the literature search results, there was no conflict or disagreement between the 2 reviewers, and the 5 studies that met the study protocol's inclusion criteria [8][9][10][11][12] together with the data from the present study protocol were included both in the qualitative and quantitative synthesis (figure 1).…”

“…In the overall analysis of 5 case series that reported sICH rates both in patients with and without incidental aneurysms, the RR of sICH did not differ between AIS patients with and without UIA (RR 5 1.60; 95% CI: 0.54-4.77; p 5 0.40) (figure 3) with no evidence of heterogeneity across included studies (I 2 5 22% and p 5 0.270 for Cochran Q test). After considering the data from the 11 patients who were reported in the studies that were excluded from the meta-analysis [5][6][7][27][28][29][30][31][32][33] …”