Preexisting Cerebral Microbleeds on Susceptibility-Weighted Magnetic Resonance Imaging and Post-Thrombolysis Bleeding Risk in 392 Patients

Gratz, Pascal P.; El-Koussy, Marwan; Hsieh, Kety Wha-Vei; von Arx, Sebastian Werner; Mono, Marie-Luise; Heldner, Mirjam Rachel; Fischer, Urs; Mattle, Heinrich P.; Zubler, Christoph; Schroth, Gerhard; Gralla, Jan; Arnold, Marcel; Jung, Simon (2014). Preexisting Cerebral Microbleeds on Susceptibility-Weighted Magnetic Resonance Imaging and Post-Thrombolysis Bleeding Risk in 392 Patients. Stroke, 45(6), pp. 1684-1688. Lippincott Williams & Wilkins 10.1161/STROKEAHA.114.004796

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Background and Purpose—The question whether cerebral microbleeds (CMBs) visible on MRI in acute stroke increase the risk for intracerebral hemorrhages (ICHs) or worse outcome after thrombolysis is unresolved. The aim of this study was to analyze the impact of CMB detected with pretreatment susceptibility-weighted MRI on ICH occurrence and outcome. Methods—From 2010 to 2013 we treated 724 patients with intravenous thrombolysis, endovascular therapy, or intravenous thrombolysis followed by endovascular therapy. A total of 392 of the 724 patients were examined with susceptibility-weighted MRI before treatment. CMBs were rated retrospectively. Multivariable regression analysis was used to determine the impact of CMB on ICH and outcome. Results—Of 392 patients, 174 were treated with intravenous thrombolysis, 150 with endovascular therapy, and 68 with intravenous thrombolysis followed by endovascular therapy. CMBs were detected in 79 (20.2%) patients. Symptomatic ICH occurred in 21 (5.4%) and asymptomatic in 75 (19.1%) patients, thereof 61 (15.6%) bleedings within and 35 (8.9%) outside the infarct. Neither the existence of CMB, their burden, predominant location nor their presumed pathogenesis influenced the risk for symptomatic or asymptomatic ICH. A higher CMB burden marginally increased the risk for ICH outside the infarct (P=0.048; odds ratio, 1.004; 95% confidence interval, 1.000–1.008). Conclusions—CMB detected on pretreatment susceptibility-weighted MRI did not increase the risk for ICH or worsen outcome, even when CMB burden, predominant location, or presumed pathogenesis was considered. There was only a small increased risk for ICH outside the infarct with increasing CMB burden that does not advise against thrombolysis in such patients.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology

UniBE Contributor:

Gratz, Pascal P.; El-Koussy, Marwan; Hsieh, Kety Wha-Vei; von Arx, Sebastian Werner; Mono, Marie-Luise; Heldner, Mirjam Rachel; Fischer, Urs; Mattle, Heinrich; Zubler, Christoph; Schroth, Gerhard; Gralla, Jan; Arnold, Marcel and Jung, Simon

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0039-2499

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Valentina Rossetti

Date Deposited:

12 Sep 2014 08:53

Last Modified:

29 Dec 2017 10:03

Publisher DOI:

10.1161/STROKEAHA.114.004796

PubMed ID:

24743433

Additional Information:

Drs Gratz, El-Koussy, Arnold, and Jung contributed equally

Uncontrolled Keywords:

mechanical thrombolysis, outcome assessment

BORIS DOI:

10.7892/boris.53724

URI:

https://boris.unibe.ch/id/eprint/53724

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