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Updated: Apr 12, 2026
Combined Near-infrared Fluorescent Imaging and Micro-computed Tomography for Directly Visualizing Cerebral Thromboemboli
Published on: September 25, 2016
Mechanical thrombectomy for acute ischemic stroke with cerebral microbleeds
Zhong-Song Shi1, Gary R Duckwiler2, Reza Jahan2
1Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Background:
The influence of cerebral microbleeds (CMBs) on post-thrombolytic hemorrhagic transformation (HT) in patients with acute ischemic stroke remains controversial.
Objective:
To investigate the association of CMBs with HT and clinical outcomes among patients with large-vessel occlusion strokes treated with mechanical thrombectomy.
Methods:
We analyzed patients with acute stroke treated with Merci Retriever, Penumbra system or stent-retriever devices. CMBs were identified on pretreatment T2-weighted, gradient-recall echo MRI. We analyzed the association of the presence, burden, and distribution of CMBs with HT, procedural complications, in-hospital mortality, and clinical outcome.
Results:
CMBs were detected in 37 (18.0%) of 206 patients. Seventy-three foci of microbleeds were identified. Fourteen patients (6.8%) had ≥2 CMBs, only 1 patient had ≥5 CMBs. Strictly lobar CMBs were found in 12 patients, strictly deep CMBs in 12 patients, strictly infratentorial CMBs in 2 patients, and mixed CMBs in 11 patients. There were no significant differences between patients with CMBs and those without CMBs in the rates of overall HT (37.8% vs 45.6%), parenchymal hematoma (16.2% vs 19.5%), procedure-related vessel perforation (5.4% vs 7.1%), in-hospital mortality (16.2% vs 18.3%), and modified Rankin Scale score 0-3 at discharge. CMBs were not independently associated with HT or in-hospital mortality in patients treated with either thrombectomy or intravenous thrombolysis followed by thrombectomy.
Conclusions:
Patients with CMBs are not at increased risk for HT and mortality following mechanical thrombectomy for acute stroke. Excluding such patients from mechanical thrombectomy is unwarranted. The risk of HT in patients with ≥5 CMBs requires further study.
Insights
Cerebral microbleeds (CMBs) do not increase the risk of hemorrhagic transformation (HT) or mortality after mechanical thrombectomy for acute stroke. Patients with CMBs can safely undergo this procedure, but those with numerous microbleeds warrant further investigation.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Research
Background:
- Cerebral microbleeds (CMBs) influence on post-thrombolytic hemorrhagic transformation (HT) in acute ischemic stroke is debated.
- Assessing CMBs' impact is crucial for guiding stroke treatment decisions.
Purpose of the Study:
- To determine the association between CMBs and HT in patients with large-vessel occlusion stroke undergoing mechanical thrombectomy.
- To evaluate the relationship of CMBs with clinical outcomes, including mortality and functional status.
Main Methods:
- Retrospective analysis of 206 acute stroke patients treated with mechanical thrombectomy devices (Merci, Penumbra, stent-retriever).
- CMBs identified on pretreatment T2-weighted, gradient-recall echo MRI.
- Statistical analysis of CMB presence, burden, and distribution against HT, complications, mortality, and clinical outcomes.
Main Results:
- CMBs were present in 18.0% of patients (37/206), with a low burden (14 patients with ≥2 CMBs, 1 with ≥5 CMBs).
- No significant differences in HT rates (37.8% vs 45.6%), parenchymal hematoma, procedural complications, or in-hospital mortality were observed between patients with and without CMBs.
- CMBs were not independently associated with HT or mortality in patients treated with thrombectomy or combined thrombolysis/thrombectomy.
Conclusions:
- Cerebral microbleeds do not elevate the risk of hemorrhagic transformation or mortality after mechanical thrombectomy for acute stroke.
- Excluding patients with CMBs from mechanical thrombectomy is not justified based on current findings.
- Further research is needed to clarify the risk of HT in patients with a high burden of CMBs (≥5).
