Intravenous thrombolysis for acute ischemic stroke patients with cerebral amyloid angiopathy

Huanwen Chen; Marco Colasurdo; Mihir Khunte; Ajay Malhotra; Dheeraj Gandhi

doi:10.1016/j.jns.2025.123586

Intravenous thrombolysis for acute ischemic stroke patients with cerebral amyloid angiopathy

J Neurol Sci. 2025 Jun 21:475:123586. doi: 10.1016/j.jns.2025.123586. Online ahead of print.

Authors

Huanwen Chen¹, Marco Colasurdo², Mihir Khunte³, Ajay Malhotra⁴, Dheeraj Gandhi⁵

Affiliations

¹ Department of Neurology, MedStar Georgetown University Hospital, Washington DC, USA.
² Department of Interventional Radiology, Oregon Health & Science University, Portland, OR, USA.
³ Warren Alpert Medical School, Brown University, Providence, RI, USA; Department of Radiology, Yale New Haven Hospital, New Haven, CT, USA.
⁴ Department of Radiology, Yale New Haven Hospital, New Haven, CT, USA.
⁵ Departments of Radiology, Neurosurgery, and Neurology, University of Maryland Medical Center, Baltimore, MD, USA. Electronic address: dheeraj.gandhi@som.umaryland.edu.

PMID: 40561725
DOI: 10.1016/j.jns.2025.123586

Abstract

Background: Cerebral amyloid angiopathy (CAA) is a hemorrhagic cerebrovascular disease that is characterized by amyloid-beta deposition in vessel walls that lead to fragility and increase the risk of rupture, and it is associated with older age. Whether intravenous thrombolysis (IVT) is safe and effective for acute ischemic stroke (AIS) patients with CAA is largely unknown.

Methods: This was an explorative analysis of a nationwide database of hospitalizations in the United States. AIS patients with CAA were identified and included in the study, and cases were divided into IVT and no-IVT groups. Propensity score matching was performed to balance treatment groups, and additional multivariable logistic regressions were used for doubly robust analyses. Primary outcome was routine discharge to home with self-care. Secondary outcomes include discharge to home, in-hospital mortality, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH).

Results: 5100 patients were identified; 498 (9.8 %) received IVT. After propensity score matching and doubly robust analyses with additional multivariable logistic regression, IVT was associated with significantly higher odds of routine discharge (adjusted OR 1.77 [95 %CI 1.12-2.80], p = 0.015), ICH (aOR 4.00 [95 %CI 2.79 to 5.75], p < 0.001), and SAH (aOR 2.42 [95 %CI 1.41-4.16], p = 0.001). IVT was not associated with significantly different odds of home discharge (aOR 0.99 [95 %CI 0.69-1.41], p = 0.94) or in-hospital mortality (aOR 0.91 [95 %CI 0.45-1.84], p = 0.80).

Conclusion: IVT for AIS patients with CAA was associated with higher odds of short-term excellent outcomes. However, IVT was associated with significantly higher odds of hemorrhage, likely suppressing its efficacy.

Keywords: Amyloid; Elderly; Hemorrhage; Stroke; Thrombolysis.