Post-Thrombolysis Hemorrhage Risk of Unruptured Intracranial Aneurysms

Background/Aims:It has been questioned whether patients with unruptured intracranial aneurysms (IAs) are at a greater risk for the development of intracerebral hemorrhage (ICH) following thrombolytic therapy. We thus performed a meta-analysis to better quantify the risk of post-thrombolysis ICH in patients with acute ischemic stroke and incidental IAs. Methods: We searched PubMed, Web of Science and EMBASE for studies assessing ICH risk in patients with acute ischemic stroke treated with thrombolysis, in relation to the presence of pretreatment lAs. A fixed-effects model meta-analysis was performed. Results: We identified four studies totaling 707 participants receiving intravenous thrombolysis. The prevalence of unruptured lAs was 6.8%. Pooled analysis demonstrates relative risk (RR) for the presence of unruptured lAs and the development of any ICH to be 1.204 (95% CI 0.709-2.043; p = 0.492; I-2 = 0.0%). The RR for sICH is 1.645 (95% CI 0.453-5.970; p = 0.449; I-2 = 28.1%). Conclusion: Intravenous thrombolysis was safe among patients with acute ischemic stroke and incidental unruptured lAs. Future prospective studies with much larger sample sizes are required to clarify the significance of the association between pre-existing unruptured IAs and the development of post-thrombolysis ICH. (C) 2014 S. Karger AG, Basel