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What causes intracerebral bleeding after thrombolysis for acute ischaemic stroke? Recent insights into mechanisms and potential biomarkers
  1. Bartosz Karaszewski1,2,
  2. Henry Houlden3,
  3. Eric E Smith4,
  4. Hugh S Markus5,
  5. Andreas Charidimou1,
  6. Christopher Levi6,
  7. David J Werring1
  1. 1University College London, Institute of Neurology & National Hospital for Neurology and Neurosurgery, Stroke Research Group, London, UK
  2. 2Department of Adult Neurology, Medical University of Gdansk & University Clinical Centre, Gdansk, Poland
  3. 3Department of Molecular Neuroscience, University College London, Institute of Neurology & National Hospital for Neurology and Neurosurgery, London, UK
  4. 4Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
  5. 5Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK
  6. 6Acute Stroke Services, University of Newcastle, John Hunter Hospital, Newcastle, New South Wales, Australia
  1. Correspondence to Dr David J Werring, University College London, Institute of Neurology & National Hospital for Neurology and Neurosurgery, Stroke Research Group, Box 6, Queen Square, London WC1N 3BG, UK; d.werring{at}ucl.ac.uk

Abstract

The overall population benefit of intravascular recombinant tissue plasminogen activator (rtPA) on functional outcome in ischaemic stroke is clear, but there are some treated patients who are harmed by early symptomatic intracranial haemorrhage (ICH). Although several clinical and radiological factors increase the risk of rtPA-related ICH, none of the currently available risk prediction tools are yet useful for practical clinical decision-making, probably reflecting our limited understanding of the underlying mechanisms. Finding new methods to identify patients at highest risk of rtPA-related ICH, or new measures to limit risk, are urgent challenges in acute stroke therapy research. In this article, we focus on the potential underlying mechanisms of rtPA-related ICH, highlight promising candidate risk biomarkers and suggest future research directions.

  • STROKE
  • CEREBROVASCULAR DISEASE
  • NEURORADIOLOGY

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