Cerebral microbleeds shouldn't dictate treatment of acute stroke: a retrospective cohort study evaluating risk of intracerebral hemorrhage

被引:26
作者
Chacon-Portillo, Martin A. [1 ]
Llinas, Rafael H. [2 ]
Marsh, Elisabeth B. [2 ]
机构
[1] Texas Childrens Hosp, Baylor Coll Med, Div Congenital Heart Surg, Michael E DeBakey Dept Surg, Houston, TX 77030 USA
[2] Johns Hopkins Univ, Sch Med, Dept Neurol, 600 N Wolfe St,Phipps 446, Baltimore, MD 21287 USA
来源
BMC NEUROLOGY | 2018年 / 18卷
关键词
Cerebral microbleed; Intracerebral hemorrhage; Intravenous thrombolysis; Stroke; Thrombolytic therapy; ACUTE ISCHEMIC-STROKE; TRIAL;
D O I
10.1186/s12883-018-1029-0
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background: Intravenous tissue plasminogen activator (IV tPA) after acute ischemic stroke carries the risk of symptomatic intracerebral hemorrhage (sICH). Cerebral microbleeds (CMBs) may indicate increased risk of hemorrhage and can be seen on magnetic resonance imaging (MRI). In this study, we examined the association between CMBs and sICH, focusing on the predictive value of their presence, burden, and location. Methods: Records from all patients presenting to two academic stroke centers with acute ischemic stroke treated with IV tPA over a 5-year period were retrospectively reviewed. Demographic, medical, and imaging variables were evaluated. The presence, number, and location (lobar vs nonlobar) of CMBs were noted on gradient echo MRI sequences obtained during the admission. Univariable and multivariable statistical models were used to determine the relationship between CMBs and hemorrhagic (symptomatic and asymptomatic) transformation. Results: Of 292 patients (mean age 62.8 years (SD 15.3), 49% African-American, 52% women), 21% (n = 62) had at least one CMB, 1% (n = 3) had > 10 CMBs, and 1% (n = 3) were diagnosed with probable cerebral amyloid angiopathy. After treatment, 16% (n = 46) developed hemorrhagic transformation, of which 6 (2%) were sICH. There was no association between CMB presence (p = .135) or location (p = .325) with sICH; however, those with a high CMB burden (> 10 CMB) were more likely to develop sICH (OR 37.8; 95% CI: 2.7-539.3; p = .007). Conclusions: Our findings support prior findings that a high CMB burden (> 10) in patients with acute stroke treated with IV tPA are associated with a higher risk of sICH. However, the overall rate of sICH in the presence of CMB is very low, indicating that the presence of CMBs by itself should not dictate the decision to treat with thrombolytics.
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页数:7
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