Intracranial Hemorrhage Patterns and Outcomes in Minor Stroke: Analysis of the TEMPO-2 Trial

BACKGROUND: Intracranial hemorrhage (ICH) negatively impacts functional outcomes after ischemic stroke, with potentially disproportionate impacts in patients with minor stroke. This study aimed to evaluate the effect of ICH on outcomes in minor ischemic stroke and to identify predictors associated with ICH. METHODS: This was a secondary analysis of the TEMPO-2 multicenter, randomized trial, which compared tenecteplase with nonthrombolytic standard care in patients within 12 hours of symptom onset with minor stroke (National Institutes of Health Stroke Scale score ≤5) and a visible vessel occlusion or perfusion mismatch. Follow-up imaging was assessed for hemorrhage using the Heidelberg classification. Symptomatic ICH was defined as any hemorrhage associated with neurological deterioration. The primary outcome was return to premorbid functional status at 90 days, measured using the modified Rankin Scale. Mixed-effects regression was used to assess the effect of ICH status on outcomes, adjusting for treatment, age, sex, baseline stroke severity, and onset-to-randomization time, with region included as a random effect. RESULTS: =0.06). CONCLUSIONS: Although most hemorrhages were minor, the presence of any ICH was strongly associated with increased mortality, highlighting that even minor hemorrhagic transformation may be prognostically significant in patients with minor ischemic stroke.

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Journal
Stroke
Published
2026-04-10
DOI
https://doi.org/10.1161/strokeaha.125.054491
Primary Topic
Intracerebral and Subarachnoid Hemorrhage Research
Type
article
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article

Intracranial Hemorrhage Patterns and Outcomes in Minor Stroke: Analysis of the TEMPO-2 Trial

Sara Massicotte, Amy YX Yu, Shelagh B. Coutts, Brian H Buck et al.
Stroke
Intracerebral and Subarachnoid Hemorrhage Research
article

Intracranial Hemorrhage Patterns and Outcomes in Minor Stroke: Analysis of the TEMPO-2 Trial

Sara Massicotte, Amy YX Yu, Shelagh B. Coutts, Brian H Buck, A. Ganesh, Keith W. Muir, Shabnam Vatanpour, Nishita Singh, Thalia Shoshana Field, Bruce C.V. Campbell, Ramana Appireddy, Jianhai Zhang, Michael D. Hill, T. Kleinig, Carlos A. Molina, on behalf of the TEMPO-2 Investigators, Philip M.C. Choi
article en

Abstract

BACKGROUND: Intracranial hemorrhage (ICH) negatively impacts functional outcomes after ischemic stroke, with potentially disproportionate impacts in patients with minor stroke. This study aimed to evaluate the effect of ICH on outcomes in minor ischemic stroke and to identify predictors associated with ICH. METHODS: This was a secondary analysis of the TEMPO-2 multicenter, randomized trial, which compared tenecteplase with nonthrombolytic standard care in patients within 12 hours of symptom onset with minor stroke (National Institutes of Health Stroke Scale score ≤5) and a visible vessel occlusion or perfusion mismatch. Follow-up imaging was assessed for hemorrhage using the Heidelberg classification. Symptomatic ICH was defined as any hemorrhage associated with neurological deterioration. The primary outcome was return to premorbid functional status at 90 days, measured using the modified Rankin Scale. Mixed-effects regression was used to assess the effect of ICH status on outcomes, adjusting for treatment, age, sex, baseline stroke severity, and onset-to-randomization time, with region included as a random effect. RESULTS: =0.06). CONCLUSIONS: Although most hemorrhages were minor, the presence of any ICH was strongly associated with increased mortality, highlighting that even minor hemorrhagic transformation may be prognostically significant in patients with minor ischemic stroke.

Stroke
Hebron University (PS), Royal Adelaide Hospital (AU), The Royal Melbourne Hospital (AU), Sunnybrook Health Science Centre (CA), Box Hill Hospital (AU), University of Alberta (CA), University of Calgary (CA), Queen's University (CA), University of Alberta Hospital (CA), Eastern Health (AU), Vall d'Hebron Hospital Universitari (ES), University of Manitoba (CA), The University of Adelaide (AU), University of Glasgow (GB)
Good health and well-being
Openalex Percentile: Top 16%
Intracerebral and Subarachnoid Hemorrhage Research
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