Safety of intravenous thrombolysis in acute ischemic stroke patients with saccular intracranial aneurysms

Background: It is not known if the presence of unruptured intracranial aneurysms can increase the risk of hemorrhage after thrombolysis for acute ischemic stroke. The goal of our study was to evaluate the risk of hemorrhage after intravenous tissue plasminogen activator in acute stroke patients with intracranial aneurysms. Methods: This is a retrospective analysis of consecutive cases of patients with acute ischemic stroke who were treated with intravenous tissue plasminogen activator at Mayo Clinic between March 2002 and June 2011 and who were evaluated with invasive or noninvasive intracranial angiography. Univariate analyses were performed with the t, Chi-square, and Fisher exact tests where appropriate. Results: Intracranial angiograms were performed in105 patients (85 magnetic resonance angiography, 19 computed tomography angiography, and 1 catheter arteriography). The mean age of the patients was 69 ± 14 years. The mean National Institutes of Health Stroke Scale score at admission was 8 ± 5. A total of 12 incidental saccular aneurysms were found in 10 (9.5%) patients, and all 10 of these patients were white. There were no subarachnoid hemorrhages during the hospital stay in any patient with or without intracranial aneurysm. The rates of symptomatic intracranial hemorrhage and 3-month clinical outcomes were similar in patients with or without intracranial aneurysms. Conclusions: Intravenous thrombolysis was safe among our patients with acute ischemic stroke and incidental intracranial saccular aneurysm.