Juan Carlos Ayala-Alvarez1, Ivan Roque-Sánchez1, Amado Jimenez-Ruiz1, Enrique Gómez-Figueroa1, Omar Cárdenas-Saenz1, José Luis Ruiz-Sandoval1
1Neurology, Hospital Civil Fray Antonio Alcalde
Objective:
Represent post-thrombolysis angioedema, a relatively common adverse effect seen after administration of alteplase for acute ischemic stroke.
Background:
r-TPA induced angioedema is a common clinical finding after medication infusion for acute stroke. The incidence of this complication ranges from 1.3-8% (3, 4). Prognosis is usually good; most patients have symptom resolution within 72 hours (5).
Design/Methods:
Literature review revealed how signs and symptoms of angioedema differ in presentation and severity. We gathered case reports from the last decade to identify the most common location of stroke, site of edema, treatment used and complications of angioedema.
Results:
Symptoms usually began within 150 minutes after initial infusion (mean 70 minutes) and usually presented with unilateral angioedema, contralaterally to the side of the stroke. Approximately 30% of the patients required mechanical ventilation; most were on treatment with ACE inhibitors. The authors usually treated patients with a combination of steroids, antihistamines, adrenalin, or Icatibant, with complete recovery within 24 to 48 hours.
Conclusions:
Patients treated with Icatibant improved within minutes and achieved full remission in the first three hours. We believe it may become the standard of care in patients presenting with this uncommon but potentially life-threatening complication.