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Title: Microbleeds, Cerebral Hemorrhage, and Functional Outcome After Stroke Thrombolysis.
Austin Authors: Charidimou, Andreas;Turc, Guillaume;Oppenheim, Catherine;Yan, Shenqiang;Scheitz, Jan F;Erdur, Hebun;Klinger-Gratz, Pascal P;El-Koussy, Marwan;Takahashi, Wakoh;Moriya, Yusuke;Wilson, Duncan;Kidwell, Chelsea S;Saver, Jeffrey L;Sallem, Asma;Moulin, Solene;Edjlali-Goujon, Myriam;Thijs, Vincent N ;Fox, Zoe;Shoamanesh, Ashkan;Albers, Gregory W;Mattle, Heinrich P;Benavente, Oscar R;Jäger, H Rolf;Ambler, Gareth;Aoki, Junya;Baron, Jean-Claude;Kimura, Kazumi;Kakuda, Wataru;Takizawa, Shunya;Jung, Simon;Nolte, Christian H;Lou, Min;Cordonnier, Charlotte;Werring, David J
Affiliation: Stroke Research Centre, UCL Institute of Neurology, London, United Kingdom
Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston
Department of Neurology, University of Arizona, Tucson
UCLA Comprehensive Stroke Center, Geffen School of Medicine, Los Angeles
Division of Neurology, Stroke and Cerebrovascular Health Program, University of British Columbia Hospital, Vancouver, Canada
Departments of Neurology and Radiology, Hôpital Sainte-Anne, Université Paris Descartes, France
Lysholm Department of Neuroradiology, National Hospital, London, United Kingdom
Department of Neurological Science, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
Department of Rehabilitation Medicine, the Jikei University School of Medicine, Tokyo, Japan
The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
Department of Statistical Science, University College London, United Kingdom
Department of Medicine (Neurology), McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada
Stanford Stroke Center, Palo Alto, CA
Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
Department of Neurology and Center for Stroke Research, Charite Universitätsmedizin, Berlin, Germany
Department of Diagnostic and Interventional Neuroradiology, and Neurology, Inselspital, University Hospital Bern, Switzerland
Department of Neurology, Tokai University School of Medicine, Japan
Univ. Lille, Inserm, CHU Lille, U1171, Degenerative and Vascular Cognitive Disorders, France
Issue Date: Aug-2017
Publication information: Stroke 2017; 48(8): 2084-2090
Abstract: Background and Purpose- 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. Methods- 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). Results- 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). Conclusions- 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.
DOI: 10.1161/STROKEAHA.116.012992
ORCID: 0000-0002-6614-8417
Journal: Stroke
PubMed URL: 28720659
Type: Journal Article
Subjects: cerebral hemorrhage
cerebral small vessel disease
Magnetic Resonance Imaging
Appears in Collections:Journal articles

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