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Abstract

RÉSUMÉ
Introduction. La thrombolyse intraveineuse constitue le traitement de référence de l'infarctus cérébral à la phase aiguë, mais son bénéfice est limité par le risque de transformation hémorragique. Les scores prédictifs actuels reposent principalement sur des données de scanner cérébral, alors que l'IRM est de plus en plus utilisée en pratique clinique et permet d'identifier des marqueurs de fragilité cérébrale (microbleeds, leucoaraïose) non pris en compte dans ces scores. L'objectif de cette étude était de rechercher les facteurs de risque de transformation hémorragique après thrombolyse intraveineuse, en incluant les paramètres d'IRM cérébrale, au Centre Hospitalier de SaintBrieuc. Méthodologie. Il s'agissait d'une étude rétrospective, menée du 1er janvier 2019 au 31 mai 2021, dans l'Unité de Soins Intensifs Neurovasculaires du Centre Hospitalier de SaintBrieuc, portant sur 123 patients thrombolysés pour un infarctus cérébral aigu. Les variables démographiques, cliniques, radiologiques et thérapeutiques ont été recueillies. Les facteurs de risque de transformation hémorragique ont été recherchés par régression logistique binaire (analyse univariée puis multivariée, seuil de signification p < 0,05). Résultats. L'âge moyen était de 71,98 ans, avec un sexratio homme/femme de 1,12. La transformation hémorragique est survenue chez 27 patients (22 %), dont 7,31 % d'hémorragies sévères. En analyse multivariée, trois facteurs étaient indépendamment associés à la transformation hémorragique : la présence de microbleeds (OR 1,48 ; IC 95 % [1,11–1,97] ; p = 0,008), la réalisation d'une thrombectomie (OR 4,15 ; IC 95 % [1,06–16,16] ; p = 0,004) et l'antécédent d'AVC ou d'AIT (OR 5,18 ; IC 95 % [1,03–26,1] ; p = 0,046). Conclusion. Les microbleeds et l'antécédent d'AVC, identifiables à l'IRM cérébrale, constituent des marqueurs de fragilité cérébrale à prendre en compte dans l'évaluation du risque hémorragique avant thrombolyse. L'intégration de ces paramètres dans les scores prédictifs pourrait améliorer la sélection des patients.


ABSTRACT
Introduction. Intravenous thrombolysis is the standard treatment for acute ischemic stroke, but its benefit is limited by the risk of hemorrhagic transformation. Current predictive scores rely mainly on computed tomography (CT) data, whereas magnetic resonance imaging (MRI) is increasingly used in clinical practice and can identify markers of cerebral fragility (microbleeds, leukoaraiosis) that are not included in these scores. This study aimed to identify risk factors for hemorrhagic transformation after intravenous thrombolysis, including brain MRI parameters, at SaintBrieuc Hospital. Methodology. We conducted a retrospective study from January 1, 2019, to May 31, 2021, in the Neurovascular Intensive Care Unit of SaintBrieuc Hospital, involving 123 patients thrombolyzed for acute ischemic stroke. Demographic, clinical, radiological, and therapeutic variables were collected. Risk factors for hemorrhagic transformation were assessed using binary logistic regression (univariate then multivariate analysis, significance threshold p < 0.05). Results. Mean age was 71.98 years, with a maletofemale ratio of 1.12. Hemorrhagic transformation occurred in 27 patients (22%), including 7.31% with severe hemorrhage. In multivariate analysis, three factors were independently associated with hemorrhagic transformation: presence of microbleeds (OR 1.48; 95% CI [1.11–1.97]; p = 0.008), performance of thrombectomy (OR 4.15; 95% CI [1.06–16.16]; p = 0.004), and history of stroke or TIA (OR 5.18; 95% CI [1.03–26.1]; p = 0.046). Conclusion. Microbleeds and history of stroke, identifiable on brain MRI, are markers of cerebral fragility that should be considered when assessing hemorrhagic risk before thrombolysis. Incorporating these parameters into predictive scores could improve patient selection.

Keywords

Hemorrhagic transformation; Thrombolysis; Ischemic stroke; Cerebral microbleeds; Brain MRI; Risk factors. Transformation hémorragique ; Thrombolyse ; AVC ischémique ; Microbleeds ; IRM cérébrale ; Facteurs de risque.

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How to Cite
N’Guessan Yves Constant Broh, Samuel Yeo, Nancy Essoin De Souza, Stéphane Abbe, Roxane Beuseize, Donissongui Soro, … Mariam Doumbia Ouattara. (2026). Risk Factors for Cerebral Hemorrhage After Thrombolysis of Ischemic Stroke: A Retrospective Study Involving 123 Patients: Facteurs de Risque de Transformation Hémorragique après Thrombolyse Intraveineuse des Infarctus Cérébraux : Une Étude Rétrospective de 123 Patients. HEALTH SCIENCES AND DISEASE, 27(10), 63–67. https://doi.org/10.67260/hsd.v27i10.7907
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