Cerebral microbleeds shouldn’t dictate treatment of acute stroke: a retrospective cohort study evaluating risk of intracerebral hemorrhage
Abstract 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,...
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| Format: | Article |
| Language: | English |
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BMC
2018-03-01
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| Series: | BMC Neurology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12883-018-1029-0 |
| _version_ | 1818160002211250176 |
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| author | Martin A. Chacon-Portillo Rafael H. Llinas Elisabeth B. Marsh |
| author_facet | Martin A. Chacon-Portillo Rafael H. Llinas Elisabeth B. Marsh |
| author_sort | Martin A. Chacon-Portillo |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-12-11T15:54:57Z |
| format | Article |
| id | doaj.art-10f8ee31f66d4aef821e293b3c7dc547 |
| institution | Directory Open Access Journal |
| issn | 1471-2377 |
| language | English |
| last_indexed | 2024-12-11T15:54:57Z |
| publishDate | 2018-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Neurology |
| spelling | doaj.art-10f8ee31f66d4aef821e293b3c7dc5472022-12-22T00:59:28ZengBMCBMC Neurology1471-23772018-03-011811710.1186/s12883-018-1029-0Cerebral microbleeds shouldn’t dictate treatment of acute stroke: a retrospective cohort study evaluating risk of intracerebral hemorrhageMartin A. Chacon-Portillo0Rafael H. Llinas1Elisabeth B. Marsh2Division of Congenital Heart Surgery, Texas Children’s Hospital, Michael E. DeBakey Department of Surgery, Baylor College of MedicineDepartment of Neurology, Johns Hopkins University School of MedicineDepartment of Neurology, Johns Hopkins University School of MedicineAbstract 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.http://link.springer.com/article/10.1186/s12883-018-1029-0Cerebral microbleedIntracerebral hemorrhageIntravenous thrombolysisStrokeThrombolytic therapy |
| spellingShingle | Martin A. Chacon-Portillo Rafael H. Llinas Elisabeth B. Marsh Cerebral microbleeds shouldn’t dictate treatment of acute stroke: a retrospective cohort study evaluating risk of intracerebral hemorrhage BMC Neurology Cerebral microbleed Intracerebral hemorrhage Intravenous thrombolysis Stroke Thrombolytic therapy |
| title | Cerebral microbleeds shouldn’t dictate treatment of acute stroke: a retrospective cohort study evaluating risk of intracerebral hemorrhage |
| title_full | Cerebral microbleeds shouldn’t dictate treatment of acute stroke: a retrospective cohort study evaluating risk of intracerebral hemorrhage |
| title_fullStr | Cerebral microbleeds shouldn’t dictate treatment of acute stroke: a retrospective cohort study evaluating risk of intracerebral hemorrhage |
| title_full_unstemmed | Cerebral microbleeds shouldn’t dictate treatment of acute stroke: a retrospective cohort study evaluating risk of intracerebral hemorrhage |
| title_short | Cerebral microbleeds shouldn’t dictate treatment of acute stroke: a retrospective cohort study evaluating risk of intracerebral hemorrhage |
| title_sort | cerebral microbleeds shouldn t dictate treatment of acute stroke a retrospective cohort study evaluating risk of intracerebral hemorrhage |
| topic | Cerebral microbleed Intracerebral hemorrhage Intravenous thrombolysis Stroke Thrombolytic therapy |
| url | http://link.springer.com/article/10.1186/s12883-018-1029-0 |
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