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Pretreatment cerebral microbleeds and symptomatic intracerebral hemorrhage post-thrombolysis: a systematic review and

Jiangzhi Yan1, Jianting Qiu1, Xiumei Wu1

  • 1Department of Neurology, Cerebrovascular Disease Center, People's Hospital, China Medical University, 33 Wenyi Road, Shenhe District, Shenyang, 110016, People's Republic of China.

Journal of Neurology
|December 14, 2018
PubMed
Abstract

Insights

Cerebral microbleeds (CMBs) in acute ischemic stroke patients predict higher rates of symptomatic intracranial hemorrhage and poor functional outcomes after intravenous thrombolysis (IVT). CMBs do not currently contraindicate IVT treatment.

Area of Science:

  • Neurology
  • Radiology
  • Stroke Medicine

Background:

  • Cerebral microbleeds (CMBs) are increasingly recognized as potential indicators of hemorrhagic complications.
  • Predicting outcomes in acute ischemic stroke patients undergoing treatment is crucial for clinical decision-making.

Purpose of the Study:

  • To investigate the association between pretreatment cerebral microbleeds (CMBs) and the incidence of symptomatic intracranial hemorrhage (sICH) and poor functional outcome (PFO).
  • To evaluate the impact of CMBs on patients with acute ischemic stroke receiving intravenous thrombolysis (IVT).

Main Methods:

  • A systematic literature search was conducted across PubMed, EMBASE, and Cochrane Library databases.
  • Meta-analysis was performed to calculate pooled relative risks (RR) for sICH and PFO in patients with and without CMBs post-IVT.
  • Data from nine studies encompassing 2407 participants were included.

Main Results:

  • Patients with CMBs showed a significantly higher incidence of sICH (6% vs. 4%, RR 1.51) compared to those without CMBs.
  • A higher cumulative incidence of poor functional outcome (PFO) at 3-6 months was observed in patients with CMBs (53% vs. 41%, RR 1.25).
  • The findings were based on data from 2407 participants across nine studies.

Conclusions:

  • Pretreatment cerebral microbleeds are associated with an increased risk of symptomatic intracranial hemorrhage and poor functional outcomes following IVT for acute ischemic stroke.
  • While CMBs indicate higher risk, they are not yet considered a definitive contraindication for IVT treatment.
  • Further research may refine the role of CMBs in guiding IVT decisions.
Keywords:
A systematic review and meta-analysisCerebral microbleedsIntravenous thrombolysisPoor function outcomeSymptomatic intracerebral hemorrhage

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