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Updated: Mar 9, 2026
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Cerebral Microbleeds and Risk of Intracerebral Hemorrhage Post Intravenous Thrombolysis
Ramin Zand1, Georgios Tsivgoulis2, Mantinderpreet Singh3
1Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee; Biocomplexity Institute, Virginia Tech, Blacksburg, Virginia.
Background:
Stroke patients who have cerebral micro bleeds (CMBs) could be potentially at a greater risk for symptomatic intracerebral hemorrhage (sICH) than those patients without CMBs. The aim of our study was to investigate whether the presence and burden of CMBs are associated with post IVT sICH.
Methods:
In this multicenter study, consecutive patients treated with intravenous tissue plasminogen activator were prospectively identified and analyzed. Patients without magnetic resonance imaging (MRI) within 24 hours of treatment were excluded. CMBs were defined as round or oval, hypointense lesions with associated blooming on T2*-weighted MRI up to 10 mm in diameter. Outcome measures included the occurrence of sICH or death.
Results:
Of 672 patients with IVT (mean age 62 ± 14 years, 52% men, median admission NIHSS: 7 points), 103 patients had CMBs on T2*-MRI. Ten patients had more than 10, whereas the remaining 93 patients had 1-10 CMBs on T2*-MRI. The rates of sICH did not differ between patients with and patients without 1-10 CMBs (5.8% versus 3.5%; P = .27). However, sICH occurred more frequently (P = .0009) in patients with > 10 CMBs (30%, 95% confidence interval [CI] by the adjusted Wald method: 10%-61%). After adjusting for potential confounders, the presence of >10 CMBs on T2*-MRI was independently (P = .0004) associated with a higher likelihood for sICH (odds ratio [OR]:13.4, 95%CI:3.2-55.9).
Conclusions:
Our findings indicate an increased risk of sICH after IVT when more than 10 CMBs are present.
Insights
Patients with over 10 cerebral micro bleeds (CMBs) face a significantly higher risk of symptomatic intracerebral hemorrhage (sICH) after intravenous thrombolysis (IVT). This finding highlights CMBs as a crucial factor in predicting post-stroke complications.
Area of Science:
- Neurology
- Radiology
- Stroke Medicine
Background:
- Cerebral micro bleeds (CMBs) may increase stroke patients' risk of symptomatic intracerebral hemorrhage (sICH).
- Previous research suggests a potential link between CMBs and adverse outcomes after intravenous thrombolysis (IVT).
Purpose of the Study:
- To investigate the association between the presence and burden of CMBs and the occurrence of sICH after IVT.
- To determine if CMBs identified on MRI predict sICH risk in stroke patients treated with IVT.
Main Methods:
- Prospective, multicenter study analyzing consecutive patients treated with IVT.
- Inclusion criteria required magnetic resonance imaging (MRI) within 24 hours of treatment.
- CMBs defined as hypointense lesions with blooming on T2*-weighted MRI; sICH and death were outcome measures.
Main Results:
- Of 672 patients, 103 had CMBs. sICH rates did not differ for 1-10 CMBs (5.8%) vs. no CMBs (3.5%).
- However, sICH occurred more frequently in patients with >10 CMBs (30%) compared to those with fewer or no CMBs (P=.0009).
- The presence of >10 CMBs independently predicted a higher likelihood of sICH (OR: 13.4, P=.0004).
Conclusions:
- An increased risk of sICH following IVT is associated with the presence of more than 10 CMBs.
- CMB burden, specifically >10 lesions, is a significant predictor of sICH after IVT.
- These findings emphasize the importance of assessing CMBs for risk stratification in stroke patients receiving IVT.
