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- W2912000413 abstract "Introduction: The number of acute ischemic stroke patients who receive IV r-tPA have been shown to be lower than those estimated to be eligible for acute thrombolysis. One potential reason providers may be hesitant to give r-tPA is fear of hemorrhagic conversion in patients with underlying vascular abnormalities. Recent guidelines changed to suggest that r-tPA administration is reasonable for unruptured, unsecured aneurysms (< 10 mm). However, the reports on which this was based involved small sample sizes, warranting further study. Also, there is incomplete information regarding the risk of hemorrhagic transformation and outcomes after r-tPA use in those with other preexisting vascular abnormalities. Methods: We performed a retrospective chart review at our academic institution of 438 patients treated with r-tPA for stroke and found 56 total patients with preexisting vascular malformations at the time of treatment. We describe the vascular conditions, and used logistic regression to predict outcomes in this population. Results: The vascular anomalies included 13 intracranial aneurysms, 14 dissections, 4 cavernomas, 10 infundibula, 3 dural venous anomalies, 1 sinus venous thrombosis, 1 cortical venous varix, 1 pseudoaneurysm, 1 vertebral intimal web, 1 fenestration, 1 basilar ectasia, 1 extracranial aneurysm, 2 dolichoectasias, 2 aortic aneurysms, and 2 aortic ectasias. Mean size of aneurysms was 4.18 mm and maximal size was 8 mm. Importantly, there was no significant association with ICH or poor outcome after r-tPA. There were no cases of hemorrhagic transformation in the population who had a cerebral aneurysm(s); this included one patient with a previously coiled basilar aneurysm. Only one patient in the entire cohort had hemorrhagic transformation following r-tPA, but the patient’s blood pressure was not well controlled following balloon angioplasty and mechanical thrombectomy after tPA administration during a time of difficult intubation which likely contributed to the ICH. Conclusions: These data support the safety of IV-tPA in those with preexisting vascular malformations, and adds to the body of literature for these relatively rare conditions." @default.
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- W2912000413 date "2019-02-01" @default.
- W2912000413 modified "2023-09-27" @default.
- W2912000413 title "Abstract TP103: The Use of Tissue Plasminogen Activator for Treatment of Acute Ischemic Stroke in Patients With Various Vascular Malformations Appears to be Safe" @default.
- W2912000413 doi "https://doi.org/10.1161/str.50.suppl_1.tp103" @default.
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