Microbleeds, Cerebral Hemorrhage, and Functional Outcome After Stroke Thrombolysis
Author:
Charidimou Andreas1, Turc Guillaume1, Oppenheim Catherine1, Yan Shenqiang1, Scheitz Jan F.1, Erdur Hebun1, Klinger-Gratz Pascal P.1, El-Koussy Marwan1, Takahashi Wakoh1, Moriya Yusuke1, Wilson Duncan1, Kidwell Chelsea S.1, Saver Jeffrey L.1, Sallem Asma1, Moulin Solene1, Edjlali-Goujon Myriam1, Thijs Vincent1, Fox Zoe1, Shoamanesh Ashkan1, Albers Gregory W.1, Mattle Heinrich P.1, Benavente Oscar R.1, Jäger H. Rolf1, Ambler Gareth1, Aoki Junya1, Baron Jean-Claude1, Kimura Kazumi1, Kakuda Wataru1, Takizawa Shunya1, Jung Simon1, Nolte Christian H.1, Lou Min1, Cordonnier Charlotte1, Werring David J.1
Affiliation:
1. From the Stroke Research Centre, UCL Institute of Neurology, London, United Kingdom (A.C., D.W., D.J.W.); Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston (A.C.); Departments of Neurology and Radiology, Hôpital Sainte-Anne, Université Paris Descartes, France (G.T., C.O., M.E.-G., J.-C.B.); Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (S.Y., M.L.); Department of Neurology and Center for Stroke Research,...
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.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)
Cited by
98 articles.
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