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Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Risk of intracerebral hemorrhage in patients with cerebral microbleeds undergoing endovascular intervention
Yannie O Y Soo1, Deyond Y W Siu, Jill Abrigo
1Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
Background And Purpose:
Cerebral microbleeds (CMBs) on MRI gradient echo images are hemosiderin deposits, which may predict intracerebral hemorrhage (ICH). The risk of ICH in patients with CMBs could be exacerbated by the use of antithrombotics. The purpose of our study is to prospectively evaluate the risk of ICH in patients with ischemic stroke who receive dual antiplatelet therapy for endovascular intervention.
Methods:
We analyzed MRI of 133 patients admitted consecutively for intra- and extracranial stenting for symptomatic large artery atherosclerosis who received aspirin and clopidogrel. Quantity and location of CMBs were recorded by neuroradiologists independent from the angioplasty team. The primary end point was symptomatic ICH as evident in CT of the brain within 12 weeks of procedure.
Results:
CMBs were identified in 23 patients. Mean number of CMBs was 2.3 ± 1.6. Four patients had >5 CMBs. Forty-seven patients had intracranial stents, 84 patients had extracranial stents, and 2 patients had both intracranial and extracranial stents. There was no difference in risk of symptomatic ICH between those with (4.3%) and without CMBs (5.5%) patient with CMBs (P=1.000).
Conclusions:
The presence of a small number of CMBs does not cause a large increase in the short-term risk of symptomatic ICH in patients with ischemic stroke who undergo endovascular intervention with dual antiplatelet therapy. The risk of ICH in patients with ≥ 5 CMBs, however, remains unclear. Further studies with a larger sample size of patients with multiple CMBs are needed.
Insights
Cerebral microbleeds (CMBs) in ischemic stroke patients undergoing endovascular therapy with dual antiplatelet therapy did not significantly increase short-term intracerebral hemorrhage (ICH) risk. Further research is needed for patients with multiple CMBs.
Area of Science:
- Neurology
- Radiology
- Cardiology
Background:
- Cerebral microbleeds (CMBs) are MRI-detected hemosiderin deposits that may predict intracerebral hemorrhage (ICH).
- Antithrombotic use, including dual antiplatelet therapy, may increase ICH risk in patients with CMBs.
Purpose of the Study:
- To prospectively evaluate the risk of ICH in ischemic stroke patients receiving dual antiplatelet therapy during endovascular intervention.
- To assess the association between cerebral microbleeds and symptomatic ICH after stenting.
Main Methods:
- Prospective analysis of 133 patients undergoing intra- and extracranial stenting for large artery atherosclerosis.
- Dual antiplatelet therapy (aspirin and clopidogrel) administered.
- CMB assessment via MRI; symptomatic ICH tracked via CT within 12 weeks.
Main Results:
- CMBs were present in 23 patients (mean 2.3 ± 1.6 CMBs); 4 patients had >5 CMBs.
- No significant difference in symptomatic ICH risk between patients with and without CMBs (4.3% vs. 5.5%, P=1.000).
Conclusions:
- A small number of CMBs does not substantially increase short-term symptomatic ICH risk in ischemic stroke patients undergoing endovascular intervention with dual antiplatelet therapy.
- The ICH risk in patients with ≥ 5 CMBs remains uncertain, necessitating larger studies.
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