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From the Department of Neurology (Dr. Kase), Boston University School of Medicine, MA; Cleveland Clinic Foundation (Drs. Furlan and Sila), OH; University of Pittsburgh Medical Center (Drs. Wechsler and Gebel), PA; University of Texas Health Sciences Center (Dr. Hart), San Antonio; Department of Radiology (Drs. Higashida, Rowley, and H.C. Roberts), University of California, San Francisco; the Delmarva Foundation for Medicine (Dr. Molinari), Easton, MD; ClinTrials Research (Dr. Frederick), Durham, NC; Abbott Laboratories, Cardiovascular Medicine Group (G.A. Schultz), Abbott Park, IL; and the Hamilton Civic Hospitals Research Centre (R.S. Roberts and M. Gent), Ontario, Canada.
Address correspondence and reprint requests to Dr. Carlos S. Kase, Department of Neurology, Boston University School of Medicine, 715 Albany Street, B-605, Boston, MA 02118; e-mail: cskase{at}bu.edu
Objective:— To analyze the frequency, clinical characteristics, and predictors of symptomatic intracerebral hemorrhage (ICH) after intraarterial (IA) thrombolysis with recombinant pro-urokinase (r-proUK) in acute ischemic stroke.
Method:— The authors conducted an exploratory analysis of symptomatic ICH from a randomized, controlled clinical trial of IA thrombolysis with r-proUK for patients with angiographically documented occlusion of the middle cerebral artery within 6 hours from stroke onset. Patients (n = 180) were randomized in a ratio of 2:1 to either 9 mg IA r-proUK over 120 minutes plus IV fixed-dose heparin or IV fixed-dose heparin alone. As opposed to intention to treat, this analysis was based on "treatment received" and includes 110 patients given r-proUK and 64 who did not receive any thrombolytic agent. The remaining six patients received out-of-protocol urokinase and were excluded from analysis. The authors analyzed centrally adjudicated ICH with associated neurologic deterioration (increase in NIH Stroke Scale [NIHSS] score of 
4 points) within 36 hours of treatment initiation.
Results:— Symptomatic ICH occurred in 12 of 110 patients (10.9%) treated with r-proUK and in two of 64 (3.1%) receiving heparin alone. ICH symptoms in r-proUK–treated patients occurred at a mean of 10.2 ± 7.4 hours after the start of treatment. Mortality after symptomatic ICH was 83% (10/12 patients). Only blood glucose was significantly associated with symptomatic ICH in r-proUK–treated patients based on univariate analyses of 24 variables: patients with baseline glucose >200 mg/dL experienced a 36% risk of symptomatic ICH compared with 9% for those with 
200 mg/dL (p = 0.022; relative risk, 4.2; 95% CI, 1.04 to 11.7).
Conclusions:— Symptomatic ICH after IA thrombolysis with r-proUK for acute ischemic stroke occurs early after treatment and has high mortality. The risk of symptomatic ICH may be increased in patients with a blood glucose >200 mg/dL at stroke onset.
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H. C. Roberts, W. P. Dillon, A. J. Furlan, L. R. Wechsler, H. A. Rowley, N. J. Fischbein, R. T. Higashida, C. Kase, G. A. Schulz, Y. Lu, et al. Computed Tomographic Findings in Patients Undergoing Intra-arterial Thrombolysis for Acute Ischemic Stroke due to Middle Cerebral Artery Occlusion: Results From the PROACT II Trial * Editorial Comment: Results From the PROACT II Trial Stroke, June 1, 2002; 33(6): 1557 - 1565. [Abstract] [Full Text] [PDF]
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C. S. Kidwell, J. L. Saver, J. Carneado, J. Sayre, S. Starkman, G. Duckwiler, Y.P. Gobin, R. Jahan, P. Vespa, J.P. Villablanca, et al. Predictors of Hemorrhagic Transformation in Patients Receiving Intra-Arterial Thrombolysis * Editorial Comment Stroke, March 1, 2002; 33(3): 717 - 724. [Abstract] [Full Text] [PDF]
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 Hyperglycemia May Increase ICH Risk After Intra-Arterial Thrombolysis Journal Watch Neurology, January 24, 2002; 2002(124): 3 - 3. [Full Text]
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