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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Clinical Outcome in Acute Ischemic Stroke Patients With Microbleeds After Thrombolytic Therapy: A Meta-Analysis
Jing Cai1, Jingjing Fu, Shenqiang Yan
1From the Neurosurgerical Intensive Care Unit, the 2nd Affiliated Hospital of Zhejiang University (JC); Department of Neurology, the 4th Affiliated Hospital of Zhejiang University (JF); Department of Neurology (SY, HH); and Department of Surgical Oncology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (CL).
Abstract:
It remains unclear whether preexisting cerebral microbleeds (CMBs) increase the risks of worse functional outcome after thrombolytic therapy. We performed a systematic review and meta-analysis to assess the risk of unfavorable outcome in patients with acute ischemic stroke and CMBs.We searched EMBASE, PubMed, and Web of Science for relevant studies assessing functional outcome in the patients with CMBs following thrombolytic therapy. Fixed-effects and random-effects models were performed.Five eligible studies including 1974 patients were pooled in meta-analysis. The prevalence of CMBs was 24.3%. The pooled analysis demonstrates odds ratio for preexisting CMBs and the achievement of favorable outcome to be 0.69 (95% CI 0.56-0.86; P = 0.001) with no evidence of statistical heterogeneity (I = 46.7%, P = 0.112).Our meta-analysis of available published data demonstrates an increased risk of worse functional outcome after thrombolytic therapy for acute ischemic stroke in patients with pre-existing CMBs. Future studies are needed to determine whether the risk outweigh the expected benefit of reperfusion therapies.
Insights
Preexisting cerebral microbleeds (CMBs) in acute ischemic stroke patients increase the risk of poor outcomes after thrombolytic therapy. This systematic review and meta-analysis confirms this association, highlighting the need for further research.
Area of Science:
- Neurology
- Radiology
- Clinical Medicine
Background:
- Cerebral microbleeds (CMBs) are common in patients with acute ischemic stroke.
- The impact of pre-existing CMBs on functional outcomes after thrombolytic therapy remains uncertain.
Purpose of the Study:
- To systematically review and meta-analyze existing studies to assess the risk of unfavorable functional outcomes in acute ischemic stroke patients with pre-existing CMBs who receive thrombolytic therapy.
Main Methods:
- A systematic literature search was conducted across EMBASE, PubMed, and Web of Science.
- Fixed-effects and random-effects models were used for meta-analysis of five eligible studies involving 1974 patients.
Main Results:
- The prevalence of CMBs in the pooled population was 24.3%.
- Pre-existing CMBs were associated with a significantly higher risk of unfavorable functional outcome (OR 0.69, 95% CI 0.56-0.86; P=0.001).
- No significant statistical heterogeneity was observed among the studies (I²=46.7%, P=0.112).
Conclusions:
- This meta-analysis indicates that pre-existing cerebral microbleeds are associated with an increased risk of worse functional outcomes following thrombolytic therapy for acute ischemic stroke.
- Further research is warranted to determine if these risks outweigh the benefits of reperfusion therapies in patients with CMBs.
