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Published on: September 25, 2016
Influence of cerebral microbleeds on mechanical thrombectomy outcomes
Seong-Joon Lee1, Yang-Ha Hwang2, Ji Man Hong1
1Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, 164, World cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Republic of Korea.
Abstract:
In ischemic stroke patients undergoing endovascular treatment (EVT), we aimed to test the hypothesis that cerebral microbleeds (CMBs) are associated with clinical outcomes, while estimating the mediating effects of hemorrhagic transformation (HT), small-vessel disease burden (white matter hyperintensities, WMH), and procedural success. From a multicenter EVT registry, patients who underwent pretreatment MR imaging were analyzed. They were trichotomized according to presence of CMBs (none vs. 1-4 vs. ≥ 5). The association between CMB burden and 3-month mRS was evaluated using multivariable ordinal logistic regression, and mediation analyses were conducted to estimate percent mediation. Of 577 patients, CMBs were present in 91 (15.8%); 67 (11.6%) had 1-4 CMBs, and 24 (4.2%) had ≥ 5. Increases in CMBs were associated with hemorrhagic complications (β = 0.27 [0.06-0.047], p = 0.010) in multivariable analysis. The CMB effect on outcome was partially mediated by post-procedural HT degree (percent mediation, 14% [0-42]), WMH (23% [7-57]) and lower rates of successful reperfusion (6% [0-25]). In conclusion, the influence of CMBs on clinical outcomes is mediated by small-vessel disease burden, post-procedural HT, and lower reperfusion rates, listed in order of percent mediation size.
Insights
Cerebral microbleeds (CMBs) in ischemic stroke patients undergoing endovascular treatment (EVT) are linked to worse outcomes. This effect is mediated by factors like white matter hyperintensities and hemorrhagic transformation.
Area of Science:
- Neurology
- Radiology
- Stroke Medicine
Background:
- Cerebral microbleeds (CMBs) are common in patients with ischemic stroke.
- The impact of CMBs on clinical outcomes following endovascular treatment (EVT) requires further investigation.
- Understanding mediating factors is crucial for improving patient management.
Purpose of the Study:
- To test the hypothesis that CMBs are associated with clinical outcomes in ischemic stroke patients undergoing EVT.
- To estimate the mediating effects of hemorrhagic transformation (HT), small-vessel disease burden (white matter hyperintensities, WMH), and procedural success on the CMB-outcome relationship.
Main Methods:
- Analysis of a multicenter EVT registry including patients with pretreatment MR imaging.
- Patients were categorized by CMB burden: none, 1-4, or ≥5.
- Multivariable ordinal logistic regression and mediation analyses were used to assess associations and mediating effects.
Main Results:
- Of 577 patients, 15.8% had CMBs.
- Increased CMBs were associated with hemorrhagic complications (p=0.010).
- The effect of CMBs on outcomes was mediated by HT (14%), WMH (23%), and successful reperfusion rates (6%).
Conclusions:
- CMB burden influences clinical outcomes in ischemic stroke patients treated with EVT.
- The relationship between CMBs and outcomes is partially mediated by small-vessel disease burden, post-procedural HT, and reperfusion success.
- These findings highlight the complex interplay of factors affecting EVT outcomes in the presence of CMBs.
