Related Experiment Video
Updated: Aug 29, 2026
Combined Near-infrared Fluorescent Imaging and Micro-computed Tomography for Directly Visualizing Cerebral Thromboemboli
Published on: September 25, 2016
Thrombolysis for ischemic stroke in patients with old microbleeds on pretreatment MRI
Laurent Derex1, Norbert Nighoghossian, Marc Hermier
1Service d'Urgences Neurovasculaires, Hôpital Neurologique, Hospices Civils de Lyon, Lyon, France. laurent.derex@chu-lyon.fr
Background:
Old asymptomatic microbleeds (MBs) visualized on T2-weighted MRI are indicative of microangiopathy. They may be a marker of increased risk of intracerebral hemorrhage (ICH) following thrombolysis. However, data regarding this potential risk are limited.
Methods:
A retrospective analysis of pretreatment T2-weighted MRI was performed in consecutive stroke patients who received intravenous tissue plasminogen activator (tPA). We aimed to assess the impact of MBs on the risk of cerebral bleeding. The frequency and location of MBs were assessed and compared with the location of ICH after thrombolysis.
Results:
Forty-four patients were studied. MBs were present on pretreatment MRI in 8 cases (18.2%). At day 1, symptomatic ICH occurred in none of 8 patients with MBs versus 1 of 36 patients without (NS). At day 1, ICH occurred in 3 of 8 patients with MBs versus 10 of 36 patients without (NS). At day 7, symptomatic ICH occurred in 1 of 8 patients with MBs versus 2 of 36 patients without (NS). At day 7, ICH occurred in 5 of 8 patients with MBs versus 12 of 36 patients without (NS). No ICH occurred at the site of an MB. ICH occurred within the ischemic area in all patients who bled.
Conclusions:
Our study suggests that stroke patients with a small number of MBs on pretreatment MRI could be treated safely with thrombolysis. Larger prospective studies are needed to address the predictive value of detection of MBs with regard to the risk of tPA-induced ICH.
Insights
Stroke patients with few asymptomatic microbleeds (MBs) may safely receive thrombolysis. Microbleeds on MRI do not increase the risk of post-thrombolysis cerebral bleeding, suggesting safer treatment options.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Medicine
Background:
- Old asymptomatic microbleeds (MBs) on T2-weighted MRI indicate microangiopathy.
- MBs may signal increased risk of intracerebral hemorrhage (ICH) after thrombolysis.
- Limited data exist on the predictive value of MBs for post-thrombolysis ICH.
Purpose of the Study:
- To assess the impact of MBs on the risk of cerebral bleeding after thrombolysis.
- To compare the frequency and location of MBs with ICH occurrence post-thrombolysis.
Main Methods:
- Retrospective analysis of pretreatment T2-weighted MRI in stroke patients receiving intravenous tissue plasminogen activator (tPA).
- Assessment of MB presence, frequency, and location.
- Comparison of ICH occurrence in patients with and without MBs.
Main Results:
- MBs were present in 18.2% of 44 studied patients.
- No significant difference in symptomatic ICH rates at day 1 or day 7 between patients with and without MBs.
- ICH did not occur at MB sites; all bleeds were within the ischemic area.
Conclusions:
- Stroke patients with a small number of MBs may be safely treated with thrombolysis.
- Further prospective studies are needed to confirm the predictive value of MBs for tPA-induced ICH.
Related Concept Videos
01:29Venous Thrombosis III: Interprofessional Care
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care