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Title: Recurrent stroke risk and cerebral microbleed burden in ischemic stroke and TIA: A meta-analysis
Austin Authors: Wilson, Duncan;Charidimou, Andreas;Ambler, Gareth;Fox, Zoe V;Gregoire, Simone;Rayson, Phillip;Imaizumi, Toshio;Fluri, Felix;Naka, Hiromitsu;Horstmann, Solveig;Veltkamp, Roland;Rothwell, Peter M;Kwa, Vincent IH;Thijs, Vincent N ;Lee, Yong-Seok;Kim, Young Dae;Huang, Yining;Wong, Ka Sing;Jäger, Hans Rolf;Werring, David J
Affiliation: Austin Health, Heidelberg, Victoria, Australia
Stroke Research Centre, UCL, London, UK
Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, UCL, London, UK
The National Hospital for Neurology and Neurosurgery, UCL, London, UK
Department of Statistical Science, UCL, London, UK
Biomedical Research Centre, UCL, London, UK
Department of Neurosurgery, Kushiro City General Hospital, Hokkaido, Japan
Department of Neurology, University Hospital Würzburg, Germany
Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
Department of Neurology, University of Heidelberg, Germany
Department of Stroke Medicine, Division of Brain Sciences, Imperial College London, UK
Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, UK
Department of Neurology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
Melbourne Brain Center, University of Melbourne, Victoria, Australia
Department of Neurology, Seoul National University Boramae Medical Center, Seoul, Korea
Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
Department of Neurology, Peking University First Hospital, Beijing, China
Division of Neurology, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
Issue Date: 2-Sep-2016 2016-09-02
Publication information: Neurology 2016; online first: 2 September
Abstract: OBJECTIVE: To determine associations between cerebral microbleed (CMB) burden with recurrent ischemic stroke (IS) and intracerebral hemorrhage (ICH) risk after IS or TIA. METHODS: We identified prospective studies of patients with IS or TIA that investigated CMBs and stroke (ICH and IS) risk during ≥3 months follow-up. Authors provided aggregate summary-level data on stroke outcomes, with CMBs categorized according to burden (single, 2-4, and ≥5 CMBs) and distribution. We calculated absolute event rates and pooled risk ratios (RR) using random-effects meta-analysis. RESULTS: We included 5,068 patients from 15 studies. There were 115/1,284 (9.6%) recurrent IS events in patients with CMBs vs 212/3,781 (5.6%) in patients without CMBs (pooled RR 1.8 for CMBs vs no CMBs; 95% confidence interval [CI] 1.4-2.5). There were 49/1,142 (4.3%) ICH events in those with CMBs vs 17/2,912 (0.58%) in those without CMBs (pooled RR 6.3 for CMBs vs no CMBs; 95% CI 3.5-11.4). Increasing CMB burden increased the risk of IS (pooled RR [95% CI] 1.8 [1.0-3.1], 2.4 [1.3-4.4], and 2.7 [1.5-4.9] for 1 CMB, 2-4 CMBs, and ≥5 CMBs, respectively) and ICH (pooled RR [95% CI] 4.6 [1.9-10.7], 5.6 [2.4-13.3], and 14.1 [6.9-29.0] for 1 CMB, 2-4 CMBs, and ≥5 CMBs, respectively). CONCLUSIONS: CMBs are associated with increased stroke risk after IS or TIA. With increasing CMB burden (compared to no CMBs), the risk of ICH increases more steeply than that of IS. However, IS absolute event rates remain higher than ICH absolute event rates in all CMB burden categories.
DOI: 10.1212/WNL.0000000000003183
PubMed URL:
Type: Journal Article
Appears in Collections:Journal articles

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