İbrahim Acır*, Hacı Ali Erdoğan, Hülya Toydemir, Vildan Yayla


Bakirköy Dr. Sadi Konuk Training and Research Hospital Istanbul/Turkey 


Introduction: The risk of hemorrhagic transformation is an important factor as it affects the mortality of patients. The aim was to determine the effect of treatment choice on hemorrhagic complications in patients treated with acute recanalization therapies.

Material and method: A total of 139 stroke patients were included in the study. Demographic data and clinical characteristics of patients were considered. Patients were grouped according to the therapy which applied such as thrombectomy, bolus dose tissue plazminogen activator (tPA)+thrombectomy, full dose tPA+thrombectomy and thrombolysis (only full dose tPA) therapy. The National Institutes of Health Stroke Scale (NIHSS) score and the modified Rankin Scale (mRS) score at the admission and computer tomography (CT) scans of patiens classified according to the European Co-operative Acute Stroke Study-II (ECASS II) classification were recorded.

Results: The mean age of 139 patients was 70.6±14 years. Thrombolysis was applied to 53 (38.1%) patients, thrombectomy to 62 (44.6%) patients, bolus dose tPA+thrombectomy to 3 (2.2%) patients, full dose tPA+thrombectomy to 19 (13.7%) patients and thrombectomy and stent were applied to 2 (1.4%) patients. Hemorrhagic transformation as parenchymal hematoma type 2 (PH2) was seen 58.3% in the thrombectomy group and 16.7% in the full dose tPA+thrombectomy group. The number of patients who underwent thrombectomy was higher than the number of patients who underwent full dose tPA+thrombectomy in each ECASS II classes and it was statistically significant (p:0.003).

Discussion: The hemorrhagic transformation in patients treated with only thrombolysis therapy was less than the other groups. It may be a predictable result due to the thrombolysis group includes patients who had low NIHSS score and small vessel infarcts. PH2 type hemorrhage was higher in the thrombectomy group compared to the tPA full dose+thrombectomy group. Therefore, tPA application before thrombectomy may cause minor hemorrhages rather than major.

Conclusion: Full dose tPA application before thrombectomy may cause less hemorrhagic transformation than only thrombectomy.


Acute stroke, thrombectomy, tPA, ECASS II.