Clinical Outcome in Acute Ischemic Stroke Patients With Microbleeds After Thrombolytic Therapy

Cai, Jing; Fu, Jingjing; Yan, Shiyu; Hu, Haitao; Chen, Lin

doi:10.1097/md.0000000000002379

Cited by 8 publications

(2 citation statements)

References 27 publications

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“…This hypothesis is also supported by the findings of a similar risk of bleeding and poor outcome after thrombolysis in association with cerebral microbleeds on pre-treatment MRI, another marker of severely diseased small cerebral vasculature. 23, 24 Furthermore, evidence exists linking the microbleed count with the overall burden of leukoaraiosis. 25, 26 While microbleeds, as compared to leukoaraiosis, may be a more specific marker of a bleeding-prone form of small vessel disease, they can only be detected on the blood product-sensitive MRI sequences.…”

Section: Discussionmentioning

confidence: 99%

Leukoaraiosis, Cerebral Hemorrhage, and Outcome After Intravenous Thrombolysis for Acute Ischemic Stroke

Charidimou

Pasi

Fiorelli

et al. 2016

Stroke

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Background-and-Purpose We performed a meta-analysis to assess whether leukoaraiosis on brain CT scans of acute ischemic stroke patients treated with intravenous (IV) thrombolysis is associated with an increased risk of symptomatic intracerebral hemorrhage (sICH) and/or poor functional outcome at 3–6 months post-stroke. Methods We searched PubMed and pooled relevant data in meta-analyses using random effects models. Using odds ratios (OR), we quantified the strength of association between the presence and severity of leukoaraiosis and post-thrombolysis sICH or 3–6 month modified Rankin Score (mRS) >2. Results Eleven eligible studies (n=7194) were pooled in meta-analysis. The risk of sICH was higher in patients with leukoaraiosis (OR: 1.55; 95%CI: 1.17–2.06, p=0.002) and severe leukoaraiosis (OR: 2.53; 95%CI: 1.92–3.34, p<0.0001), compared to patients without leukoaraiosis. Leukoaraiosis was an independent predictor of sICH in six included studies (n=4976, adjusted-OR: 1.75, 95%CI: 1.35–2.27; p<0.0001). OR for leukoaraiosis and poor 3–6 month outcome was 2.02 (95%CI: 1.54–2.65, p<0.0001), with significant statistical heterogeneity (I2:75.7%, p=0.002). In adjusted analysed, leukoaraiosis was an independent predictor of poor outcome (n=3688, adjusted-OR: 1.61, 95%CI: 1.44–1.79; p<0.0001). In post-hoc analyses, including only leukoaraiosis patients in RCTs (IST-3, NINDS, ECASS-1-2; n=2234), tPA vs. control was associated with higher sICH risk (OR: 5.50; 95%CI: 2.49–12.13), but lower poor outcome risk (OR: 0.75; 95%CI: 0.60–0.95). Conclusions Leukoaraiosis might increase post-IV thrombolysis sICH risk and poor outcome post-stroke. Despite increased sICH risk, IV tPA treatment has net clinical benefit in patients with leukoaraiosis. Given the risk of bias/confounding, these results should be considered hypothesis-generating and do not justify withholding IV thrombolysis.

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Section: Discussionmentioning

confidence: 99%

Leukoaraiosis, Cerebral Hemorrhage, and Outcome After Intravenous Thrombolysis for Acute Ischemic Stroke

Charidimou

Pasi

Fiorelli

et al. 2016

Stroke

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“…Not only the location but the number of microhemorrhages are also related to prognosis, especially in bleeding-prone conditions: it was found in patients after thrombolysis that pre-existing microbleeds were associated with disease outcome [116], furthermore microbleed number was independently linked to increased score on the modified Rankin scale [117]. Besides direct effects of these microlesions on cognition and neurologic dysfunction, effects of secondary hemorrhages after thrombolysis or the administration of antithrombotic drugs worsen functional outcome in stroke patients [117].…”

Section: Cerebral Microbleeds and Prognosismentioning

confidence: 99%

The Clinical Relevance of Cerebral Microbleeds

Zn¹,

Csécsei²,

Lovig³

et al. 2016

IJCTD

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Despite their very recent discovery and only couple decade-long existence, cerebral microbleeds are progressively investigated, trending radiological concepts in today's scientific era. In this paper, we are going to provide a short review on the most important details of cerebral microbleeds, with special focus on their clinical relevance and particular emphasis on their practical aspects with stroke prevention and therapy.

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The impact of cerebral microbleeds on intracerebral hemorrhage and poor functional outcome of acute ischemic stroke patients treated with intravenous thrombolysis: a systematic review and meta-analysis

Wang

Zheng

et al. 2016

J Neurol

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It is still controversial whether pre-existing cerebral microbleeds (CMBs) increase the risks of intracranial hemorrhage (ICH) and poor functional outcome (PFO) in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT). Therefore, we performed a systematic review and meta-analysis to determine the impact of CMBs on ICH and PFO of AIS patients with IVT. We searched PubMed, EMBASE and Web of Science from inception to August 3, 2016, with language restriction in English. We included studies that reported the relationship between CMBs and ICH or PFO after thrombolysis. Two retrospective and nine prospective studies met inclusion criteria (total 2702 patients). The overall prevalence of CMBs on pre-IVT MRI scans was 24.0%. Pre-existing CMBs on MRI scans were not significantly associated with a higher risk of early sICH (OR 1.74; 95% CI 0.91-3.33; I = 44.5%). Subgroup analyses did not substantially influence these associations. The presence of CMBs was associated with the increased risk of 3-month PFO (OR 1.58; 95% CI 1.08-2.31; I = 54.2%), PH (OR 2.14; 95% CI 1.34-3.42; I = 11.0%) and any ICH (OR 1.42; 95% CI 1.04-1.95; I = 0.0%), respectively. This meta-analysis showed that CMBs presence was not significantly associated with the increased risk of early sICH after IVT. However, the results also demonstrated that CMBs presence increased the risks of 3-month PFO, PH and any ICH after IVT. Due to a small number of included studies and methodological limitations, the results of this meta-analysis should be interpreted cautiously. CMBs presence should not be a contraindication to IVT for AIS patients based on the existing evidence.

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Clinical Outcome in Acute Ischemic Stroke Patients With Microbleeds After Thrombolytic Therapy

Cited by 8 publications

References 27 publications

Leukoaraiosis, Cerebral Hemorrhage, and Outcome After Intravenous Thrombolysis for Acute Ischemic Stroke

Leukoaraiosis, Cerebral Hemorrhage, and Outcome After Intravenous Thrombolysis for Acute Ischemic Stroke

The Clinical Relevance of Cerebral Microbleeds

The impact of cerebral microbleeds on intracerebral hemorrhage and poor functional outcome of acute ischemic stroke patients treated with intravenous thrombolysis: a systematic review and meta-analysis

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