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Article

Safety and Efficacy of Stroke Thrombolysis for Patients with Cerebral Cavernous Malformations: Literature Review and Nationwide Cohort Study

by
Huanwen Chen
1,
Rachel K. Laursen
2,
Matthew K. McIntyre
3,
Monika Jain
4,
Hamza A. Salim
5,
Dhairya A. Lakhani
6,
Ajay Malhotra
7,
Dheeraj Gandhi
1 and
Marco Colasurdo
8,*
1
Neurosurgery, University of Maryland Medical Center, Baltimore, MD 21201, USA
2
Neurology, Oregon Health and Sciences University, Portland, OR 97239, USA
3
Neurosurgery, Oregon Health and Sciences University, Portland, OR 97239, USA
4
Neurology, University of Maryland Medical Center, Baltimore, MD 21201, USA
5
Neuroradiology, MD Anderson Cancer Center, Houston, TX 77030, USA
6
Neuroradiology, West Virginia University, Morgantown, WV 26506, USA
7
Radiology, Yale New Haven Hospital, New Haven, CT 06510, USA
8
Interventional Radiology, Oregon Health and Sciences University, Portland, OR 97239, USA
*
Author to whom correspondence should be addressed.
NeuroSci 2026, 7(1), 24; https://doi.org/10.3390/neurosci7010024
Submission received: 8 October 2025 / Revised: 8 November 2025 / Accepted: 6 December 2025 / Published: 8 February 2026
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Abstract

Background: Intravenous thrombolysis (IVT) is relatively contraindicated in acute ischemic stroke (AIS) patients with intracranial vascular malformations per current guidelines. Thus, the presence of cerebral cavernous malformations (CCMs) may complicate treatment decision-making. Methods: We performed a literature review of the PubMed, Embase, Scopus, and Web of Science databases through July 2025, identifying reported cases of IVT administration in AIS patients with CCMs. Additionally, we conducted a retrospective cohort study using the Nationwide Readmissions Database (2016–2022) of AIS patients with CCM, and assessed outcomes with IVT versus no IVT treatment. The primary outcome was functional independence at discharge; secondary outcomes included mortality and intracranial hemorrhage (ICH). Results: Only 34 CCM patients across 7 studies were identified in the literature, with symptomatic ICH occurring in 2 cases (5.9%). In the nationwide cohort, 846 AIS patients with CCMs were included, of whom 240 (28.4%) received IVT. Compared to no IVT treatment, IVT was associated with significantly higher rates of functional independence (46.4% vs. 24.6%, adjusted OR [aOR] 3.04 [95% CI 1.98–4.68], p < 0.001), without significant differences in mortality (8.5% vs. 8.3%, aOR 1.40 [95% CI 0.52–3.76], p = 0.50) or ICH (20.3% vs. 16.1%, adjusted OR 1.01 [95% CI 0.53–1.93], p = 0.97). Conclusions: The current literature on the safety and efficacy of IVT in AIS patients with CCMs is limited. Our nationwide study suggests that IVT was associated with higher rates of early functional independence without increased risks of hemorrhage or death among patients with CCM.
Keywords: stroke; infarct; thrombolysis; cavernoma; cavernous malformation; hemangioma; hemorrhage stroke; infarct; thrombolysis; cavernoma; cavernous malformation; hemangioma; hemorrhage

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MDPI and ACS Style

Chen, H.; Laursen, R.K.; McIntyre, M.K.; Jain, M.; Salim, H.A.; Lakhani, D.A.; Malhotra, A.; Gandhi, D.; Colasurdo, M. Safety and Efficacy of Stroke Thrombolysis for Patients with Cerebral Cavernous Malformations: Literature Review and Nationwide Cohort Study. NeuroSci 2026, 7, 24. https://doi.org/10.3390/neurosci7010024

AMA Style

Chen H, Laursen RK, McIntyre MK, Jain M, Salim HA, Lakhani DA, Malhotra A, Gandhi D, Colasurdo M. Safety and Efficacy of Stroke Thrombolysis for Patients with Cerebral Cavernous Malformations: Literature Review and Nationwide Cohort Study. NeuroSci. 2026; 7(1):24. https://doi.org/10.3390/neurosci7010024

Chicago/Turabian Style

Chen, Huanwen, Rachel K. Laursen, Matthew K. McIntyre, Monika Jain, Hamza A. Salim, Dhairya A. Lakhani, Ajay Malhotra, Dheeraj Gandhi, and Marco Colasurdo. 2026. "Safety and Efficacy of Stroke Thrombolysis for Patients with Cerebral Cavernous Malformations: Literature Review and Nationwide Cohort Study" NeuroSci 7, no. 1: 24. https://doi.org/10.3390/neurosci7010024

APA Style

Chen, H., Laursen, R. K., McIntyre, M. K., Jain, M., Salim, H. A., Lakhani, D. A., Malhotra, A., Gandhi, D., & Colasurdo, M. (2026). Safety and Efficacy of Stroke Thrombolysis for Patients with Cerebral Cavernous Malformations: Literature Review and Nationwide Cohort Study. NeuroSci, 7(1), 24. https://doi.org/10.3390/neurosci7010024

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