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Hemi-orolingual angioedema and ACE inhibition after alteplase treatment of stroke

From the Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Foothills Hospital, Alberta, Canada.

Address correspondence and reprint requests to Dr. Michael D. Hill, Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Foothills Hospital, 1403 29 St. NW, Rm.1242A, Calgary, Alberta, Canada T2N 2T9; e-mail: michael.hill{at}calgaryhealthregion.ca

One hundred seventy-six consecutive patients treated with IV tissue plasminogen activator (tPA) for acute ischemic stroke were examined prospectively, and orolingual angioedema was found in nine (5.1%; 95% CI 2.3 to 9.5). The reaction was typically mild, transient, and contralateral to the ischemic hemisphere. Risk of angioedema was associated with angiotensin-converting enzyme inhibitors (relative risk [RR] 13.6; 95% CI 3.0 to 62.7) and signs on initial CT of ischemia in the insular and frontal cortex (RR 9.1; 95% CI 1.4 to 30.0).

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