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New Remote Cerebral Microbleeds on T2*-Weighted Echo Planar MRI After Intravenous Thrombolysis for Acute Ischemic

Bartosz Jabłoński1, Anna Gójska-Grymajło1, Daria Ossowska1,2

  • 1Department of Adult Neurology, University Clinical Center, Medical University of Gdańsk, Gdańsk, Poland.

Frontiers in Neurology
|March 4, 2022
PubMed
Abstract

Insights

Recombinant tissue plasminogen activator (rtPA) treatment for acute ischemic stroke (AIS) can lead to new cerebral microbleeds (CMBs). Baseline CMBs increase the risk of developing new microbleeds post-treatment.

Area of Science:

  • Neurology
  • Radiology
  • Cardiovascular Research

Background:

  • Intravenous recombinant tissue plasminogen activator (rtPA) is a standard treatment for acute ischemic stroke (AIS).
  • Symptomatic intracranial hemorrhage (sICH) is a known complication, but rtPA may also cause silent cerebral microbleeds (CMBs).
  • A higher CMB load is linked to cognitive impairment, necessitating investigation into rtPA's effect on CMB formation.

Purpose of the Study:

  • To determine if rtPA administration in AIS patients leads to new CMBs.
  • To assess if the initial CMB load influences the risk of hemorrhagic transformation after rtPA treatment.

Main Methods:

  • Fifty-nine AIS patients treated with rtPA underwent MRI (T2*-weighted Echo Planar Imaging) before and 7-9 days after treatment.
  • New CMBs outside the ischemic core were quantified.
  • Hemorrhagic transformation was evaluated using ECASS-II scoring.

Main Results:

  • Of 49 patients analyzed, 14 had baseline CMBs (28.6%).
  • New CMBs appeared in 30% of patients post-rtPA.
  • Baseline CMBs (RR 5.95) and lower platelet levels (RR 0.992) independently predicted new CMB formation.
  • Baseline CMBs did not correlate with hemorrhagic transformation risk.

Conclusions:

  • New CMBs occur in nearly 30% of AIS patients treated with rtPA.
  • The presence of baseline CMBs is a significant risk factor for developing new CMBs post-rtPA.
  • Baseline CMBs did not increase hemorrhagic transformation risk in this cohort.
  • Further research is needed on the link between rtPA, CMBs, and cognitive decline, especially in patients with pre-existing CMBs.
Keywords:
MRIacute ischemic strokecerebral microbleedshemorrhagic transformationneuroimagingthrombolysis

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