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Published on: March 15, 2022
Outcomes of patients with cerebral microbleeds undergoing percutaneous coronary intervention and dual antiplatelet
Masashi Fujino1, Teruo Noguchi2, Takako Torii-Yoshimura3
1Department of Cardiovascular Medicine, Suita, Osaka, Japan. fujinom@ncvc.go.jp.
Introduction:
Cerebral microbleeds (CMBs) on brain magnetic resonance imaging (MRI) are predictive of intracerebral hemorrhage (ICH). However, the risk of ICH in patients with CMBs who undergo percutaneous coronary intervention (PCI) while receiving dual antiplatelet therapy (DAPT) is unclear.
Materials And Methods:
We conducted a study on 329 consecutive patients with coronary artery disease who underwent PCI and were evaluated using a 3T MRI scanner. Based on T2*-weighted imaging, patients were classified into three groups: no CMBs, < 5 CMBs, or ≥ 5 CMBs. We determined the occurrence of ICH during follow-up.
Results:
At least 1 CMB was found in 109 (33%) patients. The mean number of CMBs per patient was 2.9 ± 3.6. Among the 109 patients with CMBs, 16 (15%) had ≥ 5 CMBs. Coronary stent implantation was performed in 321 patients (98%). DAPT was prescribed for 325 patients (99%). During a mean follow-up period of 2.3 years (interquartile range, 1.9-2.5 years), ICH occurred in one patient (1.1%) with four CMBs. There were no significant differences in the incidence of ICH (0% vs. 1.1% vs. 0%; p = 0.28). However, the rate of DAPT at 6 months of follow-up was significantly lower in patients with ≥ 5 CMBs than in patients with no CMBs or < 5 CMBs (89% vs. 91% vs. 66%, p = 0.026). Furthermore, there were no significant differences in systemic blood pressure during follow-up (123 ± 16 vs. 125 ± 16 vs. 118 ± 11 mmHg; p = 0.40).
Conclusion:
Although a substantial number of patients who underwent PCI had cerebral microbleeds, at approximately two years of follow-up, intracerebral hemorrhage was very rare in our study population.
Insights
Cerebral microbleeds (CMBs) are common in patients undergoing percutaneous coronary intervention (PCI). Intracerebral hemorrhage (ICH) risk remained very low in this population, even with dual antiplatelet therapy (DAPT).
Area of Science:
- Neurology
- Cardiology
- Radiology
Background:
- Cerebral microbleeds (CMBs) detected via MRI predict future intracerebral hemorrhage (ICH).
- The ICH risk in patients with CMBs undergoing PCI with dual antiplatelet therapy (DAPT) is not well-established.
Purpose of the Study:
- To investigate the incidence of ICH in patients with coronary artery disease who underwent PCI and had CMBs.
Main Methods:
- 329 patients with coronary artery disease undergoing PCI were evaluated for CMBs using 3T MRI.
- Patients were categorized into no CMBs, <5 CMBs, or ≥5 CMBs groups.
- ICH occurrence was monitored during a mean follow-up of 2.3 years.
Main Results:
- CMBs were present in 33% of patients; 15% had ≥5 CMBs.
- ICH occurred in only one patient (1.1%) with four CMBs.
- No significant difference in ICH incidence was observed across CMB groups (p=0.28).
Conclusions:
- Intracerebral hemorrhage is rare in patients with CMBs undergoing PCI, even with DAPT.
- Further research may explore optimal DAPT duration in this patient cohort.
