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Recurrent stroke risk and cerebral microbleed burden in ischemic stroke and TIA: A meta-analysis

Duncan Wilson1, Andreas Charidimou1, Gareth Ambler1

  • 1From the Stroke Research Centre (D.W., A.C., S.G., P.R., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery; Department of Statistical Science (G.A.) and Biomedical Research Centre (Z.V.F.), UCL, London, UK; Department of Neurosurgery (T.I.), Kushiro City General Hospital, Hokkaido, Japan; Department of Neurology (F.F.), University Hospital Würzburg, Germany; Department of Neurology (H.N.), Suiseikai Kajikawa Hospital, Hiroshima, Japan; Department of Neurology (S.H.), University of Heidelberg, Germany; Department of Stroke Medicine (R.V.), Division of Brain Sciences, Imperial College London; Nuffield Department of Clinical Neurosciences (P.M.R.), John Radcliffe Hospital, University of Oxford, UK; Department of Neurology (V.I.H.K.), Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands; Department of Neurology (V.T.), Austin Health and Melbourne Brain Center, University of Melbourne, Australia; Department of Neurology (Y.-S.L.), Seoul National University Boramae Medical Center; Department of Neurology (Y.D.K.), Yonsei University College of Medicine, Seoul, Korea; Department of Neurology (Y.H.), Peking University First Hospital, Beijing, China; Division of Neurology (K.S.W.), Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong; and Lysholm Department of Neuroradiology (H.R.J.), National Hospital for Neurology and Neurosurgery, London, UK.

Neurology
|September 4, 2016
PubMed
Abstract

Insights

Cerebral microbleeds (CMBs) significantly increase the risk of recurrent ischemic stroke (IS) and intracerebral hemorrhage (ICH) after a TIA or IS event. Higher CMB burden correlates with a steeper rise in ICH risk compared to IS risk.

Area of Science:

  • Neurology
  • Radiology
  • Epidemiology

Background:

  • Cerebral microbleeds (CMBs) are increasingly recognized markers of small vessel disease.
  • The association between CMB burden and subsequent stroke risk requires further clarification.

Purpose of the Study:

  • To investigate the relationship between cerebral microbleed burden and the risk of recurrent ischemic stroke (IS) and intracerebral hemorrhage (ICH) following an initial IS or transient ischemic attack (TIA).

Main Methods:

  • A meta-analysis was conducted on prospective studies including patients with IS or TIA.
  • Studies reporting CMBs and subsequent stroke outcomes (ICH and IS) with at least 3 months of follow-up were identified.
  • Pooled risk ratios (RR) and absolute event rates were calculated based on CMB burden (single, 2-4, and ≥5 CMBs).

Main Results:

  • The meta-analysis included 5,068 patients from 15 studies.
  • Patients with CMBs had a higher risk of recurrent IS (RR 1.8) and ICH (RR 6.3) compared to those without CMBs.
  • Increasing CMB burden significantly elevated the risk for both IS and ICH, with ICH risk rising more steeply.

Conclusions:

  • Cerebral microbleeds are a significant risk factor for recurrent stroke (IS and ICH) after IS or TIA.
  • The risk of intracerebral hemorrhage increases more dramatically with higher CMB burden than the risk of ischemic stroke.
  • Despite the steeper increase in ICH risk, absolute IS event rates remain higher across all CMB burden categories.

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