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Updated: Jan 30, 2026
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
Predictors of new remote cerebral microbleeds after IV thrombolysis for ischemic stroke
Tim Bastian Braemswig1, Kersten Villringer2, Guillaume Turc2
1From the Klinik und Hochschulambulanz für Neurologie (T.B.B., H.E., H.J.A., M.E., C.H.N., J.F.S.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (T.B.B., H.E., M.E., C.H.N., J.F.S.); Center for Stroke Research Berlin (T.B.B., K.V., G.T., J.B.F., H.J.A., M.E., C.H.N., J.F.S.), Charité-Universitätsmedizin Berlin, Germany; Department of Neurology (G.T.), Hôpital Sainte-Anne, Université Paris Descartes; INSERM U894 (G.T.), Paris, France; German Center for Cardiovascular Diseases (M.E., C.H.N., J.F.S.), partner site Berlin; German Center for Neurodegenerative Diseases (M.E.), partner site Berlin, Germany. tim-bastian.braemswig@charite.de.
Objective:
To assess the frequency, associated factors, and underlying vasculopathy of new remote cerebral microbleeds (CMB), as well as the risk of concomitant hemorrhagic complications related to new CMBs, after IV thrombolysis (IVT) in acute stroke patients.
Methods:
We conducted an observational study using data from our local thrombolysis registry. We included consecutive stroke patients with MRI (3T)-based IVT and a follow-up MRI the next day between 2008 and 2017 (n = 396). Only CMBs located outside of the ischemic lesions were considered. We also performed a meta-analysis on new CMBs after IVT that included 2 additional studies.
Results:
In our cohort, new remote CMBs occurred in 16/396 patients (4.0%) after IVT and the distribution was strictly lobar in 13/16 patients (81%). Patients with preexisting CMBs with a strictly lobar distribution were significantly more likely to have new CMBs after IVT (p = 0.014). In the random-effects meta-analysis (n = 741), the pooled cumulative frequency of new CMBs after IVT was 4.4%. A higher preexisting CMB burden (>2) was associated with a higher likelihood of new CMBs (odds ratio [OR] 3.6, 95% confidence interval [CI] 1.3-10.3) and new CMBs were associated with the occurrence of remote parenchymal hemorrhage (OR 28.8, 95% CI 8.6-96.4).
Conclusions:
New remote CMBs after IVT occurred in 4% of stroke patients, mainly had a strictly lobar distribution, and were associated with IVT-related hemorrhagic complications. Preexisting CMBs with a strictly lobar distribution and a higher CMB burden were associated with new CMBs after IVT, which may indicate an underlying cerebral amyloid angiopathy.
Insights
New remote cerebral microbleeds (CMBs) occurred in 4% of stroke patients after intravenous thrombolysis (IVT). Preexisting CMBs, especially lobar ones, increase this risk and are linked to hemorrhagic complications, suggesting cerebral amyloid angiopathy.
Area of Science:
- Neurology
- Radiology
- Stroke Medicine
Background:
- Intravenous thrombolysis (IVT) is a critical treatment for acute ischemic stroke.
- Cerebral microbleeds (CMBs) are common in stroke patients and can be associated with hemorrhagic complications.
- The occurrence and significance of new CMBs after IVT require further investigation.
Purpose of the Study:
- To determine the frequency of new remote CMBs following IVT in acute stroke.
- To identify factors associated with the development of new CMBs.
- To assess the risk of hemorrhagic complications linked to new CMBs and explore underlying vasculopathy.
Main Methods:
- Observational study of 396 stroke patients receiving IVT with follow-up MRI.
- Analysis focused on CMBs located outside ischemic lesions.
- Meta-analysis including 2 additional studies, totaling 741 patients.
Main Results:
- New remote CMBs occurred in 4.0% of the study cohort and 4.4% in the meta-analysis.
- Preexisting lobar CMBs were significantly associated with new CMBs (p=0.014).
- A higher CMB burden (>2) increased the likelihood of new CMBs (OR 3.6) and hemorrhagic complications (OR 28.8).
Conclusions:
- New remote CMBs are a notable complication after IVT, primarily with a lobar distribution.
- Preexisting CMBs, particularly those with lobar distribution and higher burden, predict new CMB formation.
- These findings suggest an underlying cerebral amyloid angiopathy and highlight the risk of IVT-related hemorrhagic complications.
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