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dc.contributor.authorCharidimou, Andreas-
dc.contributor.authorTurc, Guillaume-
dc.contributor.authorOppenheim, Catherine-
dc.contributor.authorYan, Shenqiang-
dc.contributor.authorScheitz, Jan F-
dc.contributor.authorErdur, Hebun-
dc.contributor.authorKlinger-Gratz, Pascal P-
dc.contributor.authorEl-Koussy, Marwan-
dc.contributor.authorTakahashi, Wakoh-
dc.contributor.authorMoriya, Yusuke-
dc.contributor.authorWilson, Duncan-
dc.contributor.authorKidwell, Chelsea S-
dc.contributor.authorSaver, Jeffrey L-
dc.contributor.authorSallem, Asma-
dc.contributor.authorMoulin, Solene-
dc.contributor.authorEdjlali-Goujon, Myriam-
dc.contributor.authorThijs, Vincent N-
dc.contributor.authorFox, Zoe-
dc.contributor.authorShoamanesh, Ashkan-
dc.contributor.authorAlbers, Gregory W-
dc.contributor.authorMattle, Heinrich P-
dc.contributor.authorBenavente, Oscar R-
dc.contributor.authorJäger, H Rolf-
dc.contributor.authorAmbler, Gareth-
dc.contributor.authorAoki, Junya-
dc.contributor.authorBaron, Jean-Claude-
dc.contributor.authorKimura, Kazumi-
dc.contributor.authorKakuda, Wataru-
dc.contributor.authorTakizawa, Shunya-
dc.contributor.authorJung, Simon-
dc.contributor.authorNolte, Christian H-
dc.contributor.authorLou, Min-
dc.contributor.authorCordonnier, Charlotte-
dc.contributor.authorWerring, David J-
dc.identifier.citationStroke 2017; online first: 18 July-
dc.description.abstractWe assessed whether the presence, number, and distribution of cerebral microbleeds (CMBs) on pre-intravenous thrombolysis MRI scans of acute ischemic stroke patients are We assessed whether the presence, number, and distribution of cerebral microbleeds (CMBs) on pre-intravenous thrombolysis MRI scans of acute ischemic stroke patients are associated with an increased risk of intracerebral hemorrhage (ICH) or poor functional outcome. We performed an individual patient data meta-analysis, including prospective and retrospective studies of acute ischemic stroke treated with intravenous tissue-type plasminogen activator. Using multilevel mixed-effects logistic regression, we investigated associations of pre-treatment CMB presence, burden (1, 2-4, ≥5, and >10), and presumed pathogenesis (cerebral amyloid angiopathy defined as strictly lobar CMBs and noncerebral amyloid angiopathy) with symptomatic ICH, parenchymal hematoma (within [parenchymal hemorrhage, PH] and remote from the ischemic area [remote parenchymal hemorrhage, PHr]), and poor 3- to 6-month functional outcome (modified Rankin score >2). In 1973 patients from 8 centers, the crude prevalence of CMBs was 526 of 1973 (26.7%). A total of 77 of 1973 (3.9%) patients experienced symptomatic ICH, 210 of 1806 (11.6%) experienced PH, and 56 of 1720 (3.3%) experienced PHr. In adjusted analyses, patients with CMBs (compared with those without CMBs) had increased risk of PH (odds ratio: 1.50; 95% confidence interval: 1.09-2.07; P=0.013) and PHr (odds ratio: 3.04; 95% confidence interval: 1.73-5.35; P<0.001) but not symptomatic ICH. Both cerebral amyloid angiopathy and noncerebral amyloid angiopathy patterns of CMBs were associated with PH and PHr. Increasing CMB burden category was associated with the risk of symptomatic ICH (P=0.014), PH (P=0.013), and PHr (P<0.00001). Five or more and >10 CMBs independently predicted poor 3- to 6-month outcome (odds ratio: 1.85; 95% confidence interval: 1.10-3.12; P=0.020; and odds ratio: 3.99; 95% confidence interval: 1.55-10.22; P=0.004, respectively). Increasing CMB burden is associated with increased risk of ICH (including PHr) and poor 3- to 6-month functional outcome after intravenous thrombolysis for acute ischemic stroke.-
dc.subjectcerebral hemorrhage-
dc.subjectcerebral small vessel disease-
dc.subjectmagnetic resonance imaging-
dc.titleMicrobleeds, Cerebral Hemorrhage, and Functional Outcome After Stroke Thrombolysis: Individual Patient Data Meta-Analysis.-
dc.typeJournal Article-
dc.identifier.affiliationDepartment of Neurology, Austin Health, Heidelberg, Victoria, Australiaen
dc.identifier.affiliationThe Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australiaen
dc.identifier.affiliationDepartment of Rehabilitation Medicine, the Jikei University School of Medicine, Tokyo, Japanen
dc.identifier.affiliationLysholm Department of Neuroradiology, National Hospital, London, United Kingdomen
dc.identifier.affiliationDepartment of Neurological Science, Nippon Medical School Graduate School of Medicine, Tokyo, Japanen
dc.identifier.affiliationStroke Research Centre, UCL Institute of Neurology, London, United Kingdomen
dc.identifier.affiliationHemorrhagic Stroke Research Group, Massachusetts General Hospital, Bostonen
dc.identifier.affiliationDepartments of Neurology and Radiology, Hôpital Sainte-Anne, Université Paris Descartes, Franceen
dc.identifier.affiliationDepartment of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Chinaen
dc.identifier.affiliationDepartment of Neurology and Center for Stroke Research, Charite Universitätsmedizin, Berlin, Germanyen
dc.identifier.affiliationDepartment of Diagnostic and Interventional Neuroradiology, and Neurology, Inselspital, University Hospital Bern, Switzerlanden
dc.identifier.affiliationDepartment of Neurology, Tokai University School of Medicine, Japanen
dc.identifier.affiliationDepartment of Neurology, University of Arizona, Tucsonen
dc.identifier.affiliationUCLA Comprehensive Stroke Center, Geffen School of Medicine, Los Angelesen
dc.identifier.affiliationUniv. Lille, Inserm, CHU Lille, U1171, Degenerative and Vascular Cognitive Disorders, Franceen
dc.identifier.affiliationDepartment of Statistical Science, University College London, United Kingdomen
dc.identifier.affiliationDepartment of Medicine (Neurology), McMaster University and Population Health Research Institute, Hamilton, Ontario, Canadaen
dc.identifier.affiliationStanford Stroke Center, Palo Alto, CAen
dc.identifier.affiliationDivision of Neurology, Stroke and Cerebrovascular Health Program, University of British Columbia Hospital, Vancouver, Canadaen
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