Insula ischaemia and angioedema in stroke thrombolysis

• Research type

  Research Study

• Full title

  Is insula ischaemia associated with angioedema complicating stroke thrombolysis with tissue-plasminogen activator?

• IRAS ID

  153792

• Contact name

  Craig Smith

• Contact email

  craig.smith-2@manchester.ac.uk

• Sponsor organisation

  Salford Royal NHS Foundation Trust

• Research summary

  This study and the one preceeding it (13/EM/0140) is a further analysis of existing research data.
  A legacy of a previous research study is a database of 500 consecutive patients who were admitted to Salford Comprehensive Stroke Centre between 1/1/04 and 1/5/12 and who received clot-busting drug (tPA) as part of their clinical care. A proportion of these patients (41) developed a potentially life-threatening condition called angioedema as a complication of treatment with tPA. The cause of angioedema is not clear, and our previous study explored the theory that the risk is higher in patients who take a specific medication to lower blood pressure and this was explored in the previous study. Another theory is damage (ischaemia) caused by lack of oxygen to areas of the brain called the insula cortex and frontal cortex.

  Since completing our previous study, a method for scoring presence of absence of early brain damage on baseline (pre-clot busting) brain scans has been published. The score is called ASPECTS (Alberta Stroke Programme Early CT score) and assesses damage to 10 regions within the brain including the insula and frontal cortices. It has been assessed by a number of radiologists and scoring appears reliable and consistent. We would like to assess the brain imaging data within our cohort using ASPECTS. No new data will be collected.

  The ASPECTS method, when applied to baseline (pre-tPA) CT scans can be used to predict outcome following tPA. The association between areas of brain damage seen on brain scans taken before tPA and angioedema may provide a useful tool for doctors when determining risks to specific patients. It may also generate new theories of underlying causes of angioedema.

• REC name

  West Midlands - Black Country Research Ethics Committee

• REC reference

  14/WM/0132

• Date of REC Opinion

  7 Apr 2014

• REC opinion

  Favourable Opinion