Prognostic factors of cerebral revascularisation in acute ischemic stroke at Hanoi Heart Hospital

Background: Considering the effectiveness of treatment for acute ischemic stroke (AIS)patients, the most expected method is immediate revascularization using intravenous thrombolysis or mechanical thrombectomy, or both methods. Objective: “Find factors related to post-treatment outcomes of acute ischemic stroke patients undergoing cerebral revascularization”. Method: Cross-sectional, prospective, descriptive analysis with convenient sample size. Results: From February 2018 to August 2021, 83 patients were hospitalized with a diagnosis of acute ischemic stroke or acute ischemic stroke and had cerebral revascularision either by thrombolysis or mechanical devices or both. 6.02% of them had cerebral thrombosis with mechanical devices and stenting of cerebral/carotid arteries. Mean age was 66.37±11.82 (range 31to 91 years). Mean NIHSS score was 12.57±6.70. The rate of complete recanalization was 91.56%. The mRS score of 0-2 points accounted for 48.19% at the time of discharge and 54.21% at 30 days after discharge. The rate of death or severe illness at discharge accounted for 14.45%. 30 days all-cause mortality after discharge accounted for 25.3%. Conclusion: The rate of complete reperfusion in patients with acute cerebral infarction at Hanoi Heart Hospital and good recovery rate is quite high. Factors that related to the treatment efficacy of patients with acute ischemic stroke were NIHSS score, ASPECT score, occlusion site, pre-reperfusion parenchymal damage and the selection of appropriate reperfusion measures.

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Clinical profile of patients with acute ischemic stroke receiving intravenous thrombolysis (rtPA-alteplase)

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20180078 ◽

2018 ◽

Vol 5 (1) ◽

pp. 164

Author(s):

Shiva Prasad Jagini ◽

Suresh I.

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Prospective Observational Study ◽

Primary Outcome ◽

Intravenous Thrombolysis ◽

Clinical Profile ◽

Favorable Outcome ◽

Nihss Score ◽

The Mean ◽

Centre Hospital

Background: Stroke patients are at highest risk death in the first few weeks after the event, and between 20-50% die within first month depending on type, severity, age, co-morbidities and effectiveness of treatment of complications. Objective of this study was to clinical profile of patients with acute ischemic stroke receiving intravenous thrombolysis (rtPA-alteplase).Methods: Prospective Observational study of 26 cases of acute ischemic stroke receiving IV thrombolysis using rtPA-alteplase at Kovai Medical Centre Hospital, Coimbatore over a period of 1 year 9 months.Results: 21 cases had NIHSS score of range 10 to 22. The mean NIHSS score at admission is 13.5. 15 subjects (57.7%) had achieved primary outcome in this study. MRS Score of 0 to 2 is considered as favorable outcome. In this study 20 subjects (76.92 %) had favorable outcome at the end of 3 months.Conclusions: Majority of the patients receiving rtPA-alteplase had favorable outcome.

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The Association of Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and Lymphocyte-Monocyte Ratio With Post-Thrombolysis Early Neurological Outcomes in Patients With Acute Ischemic Stroke

10.21203/rs.3.rs-117433/v1 ◽

2020 ◽

Author(s):

Pengyu Gong ◽

Yukai Liu ◽

Yachi Gong ◽

Gang Chen ◽

Xiaohao Zhang ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Characteristic Curve ◽

Intravenous Thrombolysis ◽

Nihss Score ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Neurological Outcomes ◽

Platelet Lymphocyte Ratio ◽

Cell Counts

Abstract Background and Purpose: To investigate the association of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR) with post-thrombolysis early neurological outcomes including early neurological improvement (ENI) and early neurological deterioration (END) in patients with acute ischemic stroke (AIS).Methods: AIS patients undergoing intravenous thrombolysis were enrolled from April 2016 to September 2019. Blood cell counts were sampled before thrombolysis. Post-thrombolysis END was defined as National Institutes of Health Stroke Scale (NIHSS) score increase of ≥4 within 24 hours after thrombolysis. Post-thrombolysis ENI was defined as NIHSS score decrease of ≥4 or complete recovery within 24 hours. Multivariable logistic regression analyses were performed to explore the relationship of NLR, PLR and LMR to post-thrombolysis END and ENI. We also used receiver operating characteristic curve analysis to assess the discriminative ability of three ratios in predicting END and ENI.Results: Among 1060 recruited patients, a total of 193 (18.2%) were diagnosed with ENI and 398 (37.5%) were diagnosed with END. Multivariable logistic models indicated that NLR (odds ratio [OR], 1.652; 95% confidence interval [CI] 1.510-1.807, P=0.001) and PLR (OR, 1.015; 95% CI 1.012-1.018, P=0.001) were independent factors for post-thrombolysis END. Moreover, NLR (OR, 0.686; 95% CI 0.631-0.745, P=0.001), PLR (OR, 0.997; 95% CI 0.994-0.999, P=0.006) and LMR (OR, 1.170; 95% CI 1.043-1.313, P=0.008) served as independent factors for post-thrombolysis ENI. Area under curve (AUC) of NLR, PLR and LMR to discriminate END were 0.763, 0.703 and 0.551, respectively. AUC of NLR, PLR and LMR to discriminate ENI were 0.695, 0.530 and 0.547, respectively.Conclusions: NLR and PLR were associated with and may predict post-thrombolysis END. NLR, PLR and LMR were related to post-thrombolysis ENI.

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Comparison of Treatment Methods in the Management of Acute Ischemic Stroke.

International Journal Of Medical Science And Clinical Invention ◽

10.18535/ijmsci/v7i11.03 ◽

2020 ◽

Vol 7 (11) ◽

pp. 5073-5079

Author(s):

Ertugrul Altınbilek ◽

Abdullah Algın ◽

Mustafa Çalık ◽

Ece Guven ◽

Derya Ozturk ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Arterial Occlusion ◽

Intravenous Thrombolysis ◽

Mortality Rates ◽

Treatment Modalities ◽

Complication Rates ◽

Tissue Destruction ◽

Duration Of Treatment ◽

Nihss Score

Aim: Acute ischemic stroke is an emergency clinical condition that occurs as a result of acute intracranial arterial occlusion and neural tissue destruction. In this study, we aimed to evaluate the treatment outcomes in patients who were performed intravenous thrombolysis (IVT), mechanical thrombectomy (MT), or both. Materials and Methods: In this retrospective study, 131 patients who underwent IVT, MT or both who has the diagnosis of AIS in our hospital between June 1, 2018, and February 1, 2018, were assessed. Age, sex, concomitant chronic diseases, NIHSS score, treatment-related complications, the time between disease presentation and hospital arrival, the duration of treatment, the one-month mortality rates and modified Rankin scores (MRS) were recorded. One-month mortality, NIHSS, and MRS were compared with treatment modalities and other factors. Results: The mean age of 131 patients included in the study was 71.79±12.67. The MRS did not differ significantly in the groups with IVT, MT, and IVT+MT (p> 0.05). In the IVT and MT groups, the NIHSS score increased significantly after the treatment (p <0.05). In the MT+IVT group, the NIHSS score after treatment did not change significantly (p> 0.05). Conclusion: No significant relationship between mortality rates and MRS with treatment method was found. Complication rates were also not different among three treatment groups.

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Tenecteplase versus alteplase for acute ischemic stroke thrombolysis: a systematic review and meta-analysis

Neurology Asia ◽

10.54029/2021mzi ◽

2021 ◽

Vol 26 (4) ◽

pp. 671-683

Author(s):

YinQin Hu ◽

YangBo Hou ◽

Zhen Chen ◽

Qian Xiao ◽

Huixia Chen ◽

...

Keyword(s):

Systematic Review ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Intracranial Hemorrhage ◽

Meta Analysis ◽

Intravenous Thrombolysis ◽

Cochrane Library ◽

Nihss Score ◽

Thrombolytic Drug ◽

Symptomatic Intracranial Hemorrhage

Background: Intravenous thrombolysis is the preferred clinical treatment for acute ischemic stroke. Alteplase is an intravenous thrombolytic drug used in clinical practice. Recently, studies have shown the efficacy of another intravenous thrombolytic drug, tenecteplase, and have reported that the risk of bleeding is low. However, at present, Chinese and international research has yielded controversial results regarding the efficacy and risks of tenecteplase. Therefore, this systematic review and meta- analysis of the efficacy and safety of tenecteplase were performed. Methods: PubMed, the Cochrane Library, MEDLINE, the Wanfang Database and CNKI were searched for all studies on the thrombolytic treatment of acute ischemic stroke. All studies published in English prior to March 2021 were retrieved. The studies were screened and selected based on the inclusion and exclusion criteria. Then, the data were extracted and recorded by trained researchers. RevMan 5.4 statistical software was used to analyze the data on the 24h recanalization rate, early neurological improvement (24h reduction in the National Institutes of Health Stroke Scale [NIHSS] score of at least 8 points or 24 h NIHSS score of 0~1 point), mRS score at 90 days, intracranial hemorrhage, symptomatic intracranial hemorrhage and mortality in the tenecteplase group and alteplase group. Results: A total of 565 related studies were identified through the initial searches in each database. The citations of meta-analyses and related reviews were screened for additional eligible articles. Eventually, 9 high-quality English-language articles that included 2149 patients with acute ischemic stroke (including 1035 in the tenecteplase group and 1046 in the alteplase group)were included in this meta-analysis. The meta-analysis results were as follows: (1) Efficacy: The 24 h recanalization rate with regard to vascular recanalization was significantly better in the tenecteplase group than in the alteplase group(OR = 1.83, 95% CI: 1.23~2.72, z = 2.97, P = 0.003). There was significantly greater improvement in early neurological function in the tenecteplase group than in the alteplase group (OR= 1.34, 95% CI: 1.11~1.63, Z=3.00, P =0.003). There were no significant differences in 90-day mRS scores between the two groups (mRS score =0-1, OR = 1.20, 95% CI: 0.99~1.46, z = 1.82, p = 0.07; mRS score =0-2, OR = 1.17, 95% CI: 0.94~1.45, z = 1.38, p = 0.17). However, the subgroup analysis showed that the 90-day mRS score of the 0.25 mg/kg tenecteplase group was significantly different from that of groups treated with other doses of tenecteplase (OR = 1.48, 95% CI: 1.01~2.03, z = 2.03, p = 0.04). (2) Safety: The incidences of any intracranial hemorrhage (OR = 0.91, 95% Ci: 0.55~1.49, z = 0.39, p = 0.70), symptomatic intracranial hemorrhage (OR = 1.21, 95% CI: 0.63~2.32, z = 0.56 P = 0.57), and mortality (OR = 0.85, 95% CI: 0.57~1.26, z = 0.82, p = 0.41) were not significantly different between the tenecteplase and alteplase groups. Conclusions: Tenecteplase can significantly increase the 24-hour vascular recanalization rate and improve the neurological prognosis of patients with acute ischemic stroke and it does not increase the risk of intracranial hemorrhage or mortality.

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Abstract TP54: Topographical Aspects Collateral Score is a Useful Prognostic Factor in Thrombolysed Anterior Circulation Acute Ischemic Stroke Patients

Stroke ◽

10.1161/str.47.suppl_1.tp54 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Leonard Yeo ◽

Prakash Paliwal ◽

Teoh Hock Luen ◽

Rahul Rathakrishnan ◽

Derek Soon ◽

...

Keyword(s):

Logistic Regression ◽

Ischemic Stroke ◽

Carotid Artery ◽

Clinical Outcome ◽

Acute Ischemic Stroke ◽

Prognostic Value ◽

Intravenous Thrombolysis ◽

Anterior Circulation ◽

Nihss Score ◽

Multivariable Logistic Regression

Background: the ASPECTS- collateral score on CT-angiograms was shown to be successful in prognosticating functional outcomes and complications during intravenous thrombolysis in acute ischemic stroke (AIS). We studied predetermined topological information to see if any specific region had more prognostic value. Methods: consecutive patients from 2010-2014 with intracranial internal carotid artery, M1 or M2 middle carotid artery occlusions treated with intravenous thrombolysis were included. The primary outcome measure was good clinical outcome (3-month modified Rankin Scale score 0-1). We scored each region as 0= no collaterals, 1= poor compared to contralateral and 2= good collaterals. Prognostic value of the 6 cortical ASPECTS-collateral regions in predicting outcomes was determined by multivariable logistic regression. Results: 310 patients were included (Median age, 66.1±14.5 years; median National Institutes of Health Stroke Scale (NIHSS)- 18 points (range 3-36). Inter-rater reliability for ASPECTS-collaterals was good (κ=0.78). There was no Statistical collinearity among ASPECTS-collateral regions. Using multivariable logistic regression, only the M5 region (odds ratio, 2.72, 95%CI 1.52-4.84, p =0.001), age (OR 0.957 per yr 95%CI 0.936-0.978, p <0.001), Diabetes (OR 0.367, 95%CI 0.193- 0.700, p =0.002) and NIHSSS (OR 0.878 per point, 95%CI 0.836-0.922, p=0.001) were significantly associated with good outcomes. When compared with NIHSS, the receiver operating characteristic curves for NIHSS+M5 (area under the curve, 0.749) correlated well with clinical severity scores. Addition of M5 collateral score showed a statistically significant additive effect to the NIHSS score for predicting good outcomes (Z score: -1.684, p=0.045). Conclusions: Involvement of the parietal region (M5) regions is a reliable predictor of clinical outcome in anterior circulation large artery occlusion. This simple radiological marker can strengthen the clinical NIHSS score and may be considered during prognostication

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Earlier IV thrombolysis and mechanical thrombectomy in acute ischemic stroke are associated with a better recanalization

Clinical and Translational Neuroscience ◽

10.1177/2514183x19855602 ◽

2019 ◽

Vol 3 (1) ◽

pp. 2514183X1985560

Author(s):

Nicolas Nicastro ◽

Antoine F Eger ◽

Iman I Boukrid ◽

Hubertus FG Mueller ◽

Paolo Machi ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Multinomial Logistic Regression ◽

Treatment Options ◽

Intravenous Thrombolysis ◽

Nihss Score ◽

Recommended Treatment ◽

Mechanical Procedure ◽

Proximal Middle Cerebral Artery

Introduction: Combined intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) are the recommended treatment options for acute ischemic stroke (AIS). It is unclear whether earlier IVT and MT management can predict complete vessel recanalization. Methods: In this single-center retrospective observational study, we included 81 consecutive subjects with proximal middle cerebral artery AIS (age 70.5 ± 14.2 years, 53% female) who had both IVT and MT. We assessed recanalization after mechanical procedure according to modified thrombolysis in cerebral infarction (TICI) score as well as the National Institute of Health Stroke Scale (NIHSS) score at 24 h. Outcomes were modified Rankin Scale (mRS) at discharge, mRS at 3 months, death at 3 months, and prevalence of intracerebral hemorrhage during hospitalization. Results: Multinomial logistic regression ( χ 2 = 49.4, p = 0.0075, pseudo- R 2 = 0.26) showed that complete recanalization (TICI score = 3) was predicted by lower door-to-MT time ( p = 0.014, 95% confidence interval (CI) = −0.09 to −0.01) and lower symptoms-to-IVT time ( p = 0.045, 95% CI = −0.038 to −0.0004). An NIHSS score ≥10 at 24 h was predicted by higher baseline NIHSS ( p < 0.0001) and lower TICI score ( p = 0.009). Lower NIHSS at 24 h predicted a good outcome according to mRS at 3 months ( p = 0.006). Similarly, higher NIHSS at 24 h was a predictor of death at 3 months ( p = 0.013). Conclusions: The present study suggests that bridging therapy may improve vascular recanalization when both IVT and MT are performed earlier.

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Advanced Neuroimaging Preceding Intravenous Thrombolysis in Acute Ischemic Stroke Patients Is Safe and Effective

Journal of Clinical Medicine ◽

10.3390/jcm10132819 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2819

Author(s):

Klearchos Psychogios ◽

Apostolos Safouris ◽

Odysseas Kargiotis ◽

Georgios Magoufis ◽

Athina Andrikopoulou ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Treatment Time ◽

Intravenous Thrombolysis ◽

Neurological Status ◽

Functional Independence ◽

Nihss Score ◽

Prior Use ◽

Study Population ◽

Important Means

Advanced neuroimaging is one of the most important means that we have in the attempt to overcome time constraints and expand the use of intravenous thrombolysis (IVT). We assessed whether, and how, the prior use of advanced neuroimaging (AN), and more specifically CT/MR perfusion post-processed with RAPID software, regardless of time from symptoms onset, affected the outcomes of acute ischemic stroke (AIS) patients who received IVT. Methods. We retrospectively evaluated consecutive AIS patients who received intravenous thrombolysis monotherapy (without endovascular reperfusion) during a six-year period. The study population was divided into two groups according to the neuroimaging protocol used prior to IVT administration in AIS patients (AN+ vs. AN−). Safety outcomes included any intracranial hemorrhage (ICH) and 3-month mortality. Effectiveness outcomes included door-to-needle time, neurological status (NIHSS-score) on discharge, and functional status at three months assessed by the modified Rankin Scale (mRS). Results. The rate of IVT monotherapy increased from ten patients per year (n = 29) in the AN− to fifteen patients per year (n = 47) in the AN+ group. Although the onset-to-treatment time was longer in the AN+ cohort, the two groups did not differ in door-to-needle time, discharge NIHSS-score, symptomatic ICH, any ICH, 3-month favorable functional outcome (mRS-scores of 0–1), 3-month functional independence (mRS-scores of 0–2), distribution of 3-month mRS-scores, or 3-month mortality. Conclusion. Our pilot observational study showed that the incorporation of advanced neuroimaging in the acute stroke chain pathway in AIS patients increases the yield of IVT administration without affecting the effectiveness and safety of the treatment.

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Predictors for symptomatic intracranial hemorrhage after intravenous thrombolysis with acute ischemic stroke within 6 h in northern China: a multicenter, retrospective study

BMC Neurology ◽

10.1186/s12883-021-02534-9 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Yuan Xue ◽

Shan Li ◽

Yuanyuan Xiang ◽

Ziran Wang ◽

Fengyun Wang ◽

...

Keyword(s):

Ischemic Stroke ◽

Blood Cell ◽

Acute Ischemic Stroke ◽

White Blood Cell ◽

Predictive Factors ◽

Intravenous Thrombolysis ◽

Northern China ◽

Blood Cell Count ◽

Nihss Score ◽

Symptomatic Intracranial Hemorrhage

Abstract Background and purpose This study assessed the predictive factors for symptomatic intracranial hemorrhage (sICH) in patients with acute ischemic stroke (AIS) after receiving intravenous thrombolysis (IVT) within 6 h in northern China. Methods We retrospectively analyzed ischemic stroke patients who were treated with IVT between November 2016 and December 2018 in 19 hospitals in Shandong Province, China. Potential predictors of sICH were investigated using univariate and multivariate analyses. Results Of the 1293 enrolled patients (845 men, aged 62 ± 11 years), 33 (2.6%) developed sICH. The patients with sICH had increased coronary heart disease (36.4% vs. 13.7%, P = 0.001), more severe stroke (mean National Institutes of Health Stroke Scale [NIHSS] score on admission of 14 vs.7, P < 0.001), longer door-to-needle time [DNT] (66 min vs. 50 min, P < 0.001), higher blood glucose on admission, higher white blood cell counts (9000/mm3 vs. 7950/mm3, P = 0.004) and higher neutrophils ratios (73.4% vs. 67.2%, P = 0.006) et al. According to the results of multivariate analysis, the frequency of sICH was independently associated with the NIHSS score (OR = 3.38; 95%CI [1.50–7.63]; P = 0.003), DNT (OR = 4.52; 95%CI [1.69–12.12]; P = 0.003), and white blood cell count (OR = 3.59; 95%CI [1.50–8.61]; P = 0.004). When these three predictive factors were aggregated, compared with participants without any factors, the multi-adjusted odds ratios (95% confidence intervals) of sICH for persons concurrently having one, two or three of these factors were 2.28 (0.25–20.74), 15.37 (1.96–120.90) and 29.05 (3.13–270.11), respectively (P for linear trend < 0.001), compared with participants without any factors. Conclusion NIHSS scores higher than 10 on admission, a DNT > 50 min, and a white blood cell count ≥9000/mm3 were independent risk factors for sICH in Chinese patients within 6 h after IVT for AIS.

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Non-atrial fibrillation was associated with early neurological improvement after intravenous thrombolysis with rt-PA in patients with acute ischemic stroke

10.21203/rs.2.405/v1 ◽

2019 ◽

Author(s):

Jie Liu ◽

Jiaqi Huang ◽

Huimin Xu ◽

Haibin Dai

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Treatment Time ◽

Independent Predictor ◽

Multivariable Analysis ◽

Laboratory Data ◽

Intravenous Thrombolysis ◽

Nihss Score ◽

Neurological Improvement

Abstract Background To investigate the factors associated with early neurological improvement of intravenous recombinant tissue plasminogen activator (rt-PA) treatment to acute ischemic stroke (AIS) within 4.5 hours of onset. Methods Demographics onset to treatment time, risk factors, and clinical and laboratory data of 209 AIS patients undergoing intravenous rt-PA therapy at the Second Affiliated Hospital, Zhejiang University School of Medicine between January 2013 and August 2016 were retrospectively analyzed. The National Institute of Health Stroke Scale (NIHSS) score was recorded before thrombolytic therapy, 24 h after the treatment and 7 d after the treatment to evaluate the recovery of neurological function. A multivariate logistic regression analysis was performed to assess the outcomes. Results Of the 209 AIS patients treated by intravenous thrombolysis with rt-PA. Low-density lipoprotein (LDL) levels were significantly lower (P < 0.05) in patients with early neurological improvement. The multivariable analysis showed that non-atrial fibrillation (AF) was independently associated with early neurological improvement at 24 h and 7 d after thrombolysis. Onset to treatment time was an independent predictor (P < 0.05) for early neurological improvement at 7 d after thrombolysis. The NIHSS score and diastolic blood pressure on admission were associated with symptomatic intracerebral hemorrhagic (sICH) transformation. Conclusions Non-AF was independently associated with early neurological improvement after intravenous thrombolysis in AIS patients, but non-AF was not associated with the occurrence of sICH. Onset to treatment time was an independent predictor of early neurological improvement at 7 d after thrombolysis in AIS patients.

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Predictors of Hemorrhagic Transformation in Patients Receiving r-tPA

QJM ◽

10.1093/qjmed/hcaa054.017 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

T K Alosh ◽

H Aref ◽

M K Elewa ◽

A A Mohamed

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Intravenous Thrombolysis ◽

Hemorrhagic Transformation ◽

University Hospital ◽

Tissue Type ◽

P Value ◽

Cross Sectional ◽

Specialized Hospital ◽

Hospital Patients

Abstract Background intravenous recombinant tissue-type plasminogen activator (r-tPA) is a proven intervention for acute ischemic stroke patients. The rationale behind the use of r-tPA in ischemic stroke is breaking down the clot and recanalization of the occluded blood vessels. The restoration of blood vessel patency is meaningful only if the brain tissue of the ischemic area is still viable. Intravenous thrombolysis showed moderate benefit upon administration between three and four and half hours from stroke onset. Aim of the Work assess the risk factors that lead to occurrence of hemorrhagic transformation in patients with acute ischemic stroke received intravenous thrombolytic during their hospital stay. Patients and Methods This is a retrospective cross-sectional observational study conducted in Ain Shams University hospital and Ain Shams University Specialized hospital. 200 patients were included in the study. All were in-patients, admitted in the stroke unit either in Ain Shams University hospital or Ain Shams University Specialized hospital. Patients were diagnosed by neurological history, clinical examination and radiological investigations (CT scan with or without MRI brain stroke protocol). The diagnosis of stroke must be made by a neurologist. Results there was statistically significant association found between hemorrhagic transformation and smoking and also onset of stroke while no statistically significant association found with BP during injection and RBS. Conclusion there was highly statistically significant associaton between hemorrhagic transformation and onset of stroke with p-value = 0.006 and OR (95% CI) 5.92 (1.656–21.165) while there was statistically significant association found with smoking with p-value = 0.012 and OR (95% CI) 2.424 (1.214–4.844).

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