Andrés García Pastor
Ana María Iglesias Mohedano
Fernando Díaz Otero
Pilar Vázquez Alén
Yolanda Fernández Bullido
Marta Vales Montero
Background and Aims: Orolingual angioedema (OA) after intravenous thrombolysis with alteplase in acute ischemic stroke is a potentially life-threatening complication. Our objective was to describe the characteristics and management of OA and to identify related factors. Methods: We conducted a retrospective review of patients with ischemic stroke treated with intravenous alteplase in our institution during 8 consecutive years. Patients who developed OA (OA+ group) were recorded. We compared baseline and clinical characteristics of OA+ patients and those who did not develop angioedema (OA-) using bivariate analysis. Results: 512 patients were included. A total number of 7 patients (1,37%) developed OA, which was unilateral in 4 cases (in 3 of them OA was contralateral to an insular ischemic lesion). All OA+ patients had a previous history of hypertension, while in OA- previous hypertension was present in only 58%, [p=0.045]. OA was also related with diabetes (OR: 8,98 [CI 95%: 1,72-46,90; p=0,008]) and previous treatment with ACE inhibitors (OR: 12,53 [CI 95%: 2.39-65,67; p = 0,002]). All OA were treated with corticosteroids, antihistamines were used in 3 cases, and icatibant (a novel B2 bradikynin receptor antagonist) was administered to one patient, resulting apparently in a more rapid resolution of the OA. In one case, endotracheal intubation was required due to airway compromise. Conclusions: OA occurred in 1,37% of stroke patients treated with intravenous alteplase in our centre. According to our results, OA seems to be related with previous treatment with ACE inhibitors, history of diabetes and hypertension. Unilateral OA could be associated with contralateral insular involvement.
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