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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Microbleed Status and 3-Month Outcome After Intravenous Thrombolysis in 717 Patients With Acute Ischemic Stroke
Guillaume Turc1, Asmaa Sallem2, Solène Moulin2
1From the Departments of Neurology (G.T., J.-C.B., J.-L.M.) and Radiology (M.T., A.M., C.O.), Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S894, DHU Neurovasc, Paris, France; and Departments of Neurology (S.M., D.L., C.C.) and Radiology (A.S., M.E., X.L.), Lille University Hospital and Université de Lille, UDSL, INSERM U1171, Lille, France. g.turc@ch-sainte-anne.fr.
Background And Purpose:
Whether cerebral microbleeds (CMBs) detected on pretreatment magnetic resonance imaging increase the risks of symptomatic intracranial hemorrhage (sICH) and, most importantly, poor outcome in patients treated by intravenous thrombolysis for acute ischemic stroke is still debated. We assessed the effect of CMB presence and burden on 3-month modified Rankin Scale and sICH in a multicentric cohort.
Methods:
We analyzed prospectively collected data of consecutive patients solely treated by intravenous thrombolysis for acute ischemic stroke, in 2 centers where magnetic resonance imaging is the first-line pretreatment imaging. Neuroradiologists blinded to clinical data rated CMBs on T2* sequence using a validated scale. Logistic regressions were used to assess relationships between CMBs and 3-month modified Rankin Scale or sICH.
Results:
Among 717 patients, 150 (20.9%) had ≥1 CMBs. CMB burden was associated with worse modified Rankin Scale in univariable shift analysis (odds ratio, 1.07; 95% confidence interval, 1.00-1.15 per 1-CMB increase; P=0.049), but significance was lost after adjustment for age, hypertension, and atrial fibrillation (odds ratio, 1.03; 95% confidence interval, 0.96-1.11 per 1-CMB increase; P=0.37). Results remained nonsignificant when taking into account CMB location or presumed underlying vasculopathy. The incidence of sICH ranged from 3.8% to 9.1%, depending on the definition. Neither CMB presence, burden, location, nor presumed underlying vasculopathy was independently associated with sICH.
Conclusions:
Poor outcome or sICH was not associated with CMB presence or burden on pre-intravenous thrombolysis magnetic resonance imaging after adjustment for confounding factors. An individual patient data meta-analysis is needed to determine whether a subgroup of patients with CMBs carries an independent risk of poor outcome that might outweigh the expected benefit of intravenous thrombolysis.
Insights
Cerebral microbleeds (CMBs) on MRI before intravenous thrombolysis for acute ischemic stroke did not independently predict poor outcomes or symptomatic intracranial hemorrhage (sICH). Further meta-analysis is needed to confirm these findings in specific patient subgroups.
Area of Science:
- Neurology
- Radiology
- Stroke Medicine
Background:
- Cerebral microbleeds (CMBs) are common findings on pretreatment MRI in acute ischemic stroke patients.
- The clinical significance of CMBs regarding outcomes after intravenous thrombolysis remains debated.
Purpose of the Study:
- To assess the association between CMB presence and burden with symptomatic intracranial hemorrhage (sICH) and poor functional outcome (3-month modified Rankin Scale).
- To investigate the impact of CMBs in patients treated with intravenous thrombolysis for acute ischemic stroke.
Main Methods:
- Analysis of prospectively collected data from 717 acute ischemic stroke patients treated with intravenous thrombolysis.
- MRI-detected CMBs were rated by blinded neuroradiologists using a validated scale.
- Logistic regression models were used to evaluate the relationship between CMBs and outcomes.
Main Results:
- 150 patients (20.9%) had CMBs. CMB burden showed a univariable association with worse outcomes, but this was not significant after adjusting for confounders.
- Neither CMB presence, burden, location, nor presumed vasculopathy was independently associated with sICH or poor outcome.
Conclusions:
- CMB presence or burden on pretreatment MRI is not an independent predictor of poor outcome or sICH after intravenous thrombolysis.
- An individual patient data meta-analysis is warranted to explore potential independent risks in specific CMB patient subgroups.
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