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Contribution of Deep Microbleeds to Stroke Recurrence: Differences between Patients with Past Deep Intracerebral
Toshio Imaizumi1, Shigeru Inamura1, Tatsufumi Nomura1
1Department of Neurosurgery, Kushiro City General Hospital, Kushiro, Hokkaido, Japan.
Background:
This study investigated the contribution of deep cerebral microbleeds (MBs) to stroke recurrences in patients with histories of deep intracerebral hemorrhages (ICHs) or lacunar infarctions (LIs).
Methods:
We prospectively analyzed stroke recurrences in patients admitted to our hospital who were treated for deep ICHs or LIs between April 2004 and December 2011. The number of deep MBs was counted on admission. Stroke recurrence-free rate curves were generated with the Kaplan-Meier method using the log-rank test. The odds ratios (ORs) for recurrent strokes were derived using multivariate logistic regression models, based on deep MBs and risk factors.
Results:
We evaluated magnetic resonance images or the recurrences of 231 deep-ICH patients (92 women, 68.0 ± 12.0 years old) and 309 LI patients (140 women, 70.7 ± 11.7 years old). The incidences of deep ICHs (1.5%/year) and LIs (2.1%/year) presenting as stroke recurrences were significantly larger in LI patients with deep MBs than in those without (.01 [P = .0001] and .08%/year [P = .005], respectively). However, there was no significant difference between deep-ICH patients with and without MBs in terms of incidence of recurrences. Multivariate analyses revealed that deep MBs independently and significantly elevated the rate of deep ICHs (OR, 19.0; P = .007) or LIs (OR, 3.62; P = .008) presenting as recurrences in LI patients, but not in deep-ICH patients, when adjusted for stroke risk factors.
Conclusions:
There may be differences between patients with deep ICHs and those with LIs in terms of the contribution of deep MBs to stroke recurrence.
Insights
Deep cerebral microbleeds increase stroke recurrence risk in patients with lacunar infarctions but not deep intracerebral hemorrhages. This suggests different underlying mechanisms contribute to recurrent strokes in these patient groups.
Area of Science:
- Neurology
- Cerebrovascular Diseases
- Stroke Research
Background:
- Investigates the role of deep cerebral microbleeds (MBs) in recurrent strokes.
- Focuses on patients with prior deep intracerebral hemorrhages (ICHs) or lacunar infarctions (LIs).
Purpose of the Study:
- To determine if deep MBs contribute to stroke recurrence in patients with ICHs or LIs.
- To compare the impact of MBs on recurrence rates between ICH and LI patient cohorts.
Main Methods:
- Prospective analysis of stroke recurrences in 231 deep-ICH and 309 LI patients.
- Counting deep MBs on admission and generating recurrence-free survival curves.
- Multivariate logistic regression to assess MBs as independent predictors of recurrence.
Main Results:
- LI patients with deep MBs showed significantly higher recurrence rates (1.5%/year) than those without (0.01%/year).
- Deep MBs independently elevated ICH (OR 19.0) and LI (OR 3.62) recurrence rates in LI patients.
- No significant difference in recurrence rates was observed between deep-ICH patients with and without MBs.
Conclusions:
- Deep cerebral microbleeds appear to be a significant independent risk factor for stroke recurrence in lacunar infarction patients.
- The contribution of deep MBs to stroke recurrence may differ between patients with deep intracerebral hemorrhages and those with lacunar infarctions.
