Mechanical thrombectomy for acute ischemic stroke with cerebral microbleeds

Shi, Zhong‐Song; Duckwiler, Gary; Jahan, Reza; Tateshima, Satoshi; Gonzalez, Nestor R.; Szeder, Viktor; Saver, Jeffrey L.; Kim, Doojin; Ali, Latisha K; Starkman, Sidney; Vespa, Paul; Salamon, Noriko; Villablanca, J. Pablo; Viñuela, Fernando; Feng, Lei; Loh, Yince; Liebeskind, David S

doi:10.1136/neurintsurg-2015-011765

Cited by 31 publications

(31 citation statements)

References 28 publications

(29 reference statements)

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“…175 One study found that, in 206 patients treated with thrombectomy for acute ischemic stroke, baseline microbleeds did not predict parenchymal hematoma formation (rate with microbleeds, 16%; rate without microbleeds, 19%) or modified Rankin Scale score at discharge. 176 Other studies did not report thrombectomy subgroups separately. 167 There are insufficient data to assess associations between the presence of baseline CMBs and sICH or outcome in patients treated with intra-arterial thrombolysis.…”

Section: Safety Of Intravenous Thrombolysis and Acute Ischemic Strokementioning

confidence: 99%

Prevention of Stroke in Patients With Silent Cerebrovascular Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

Smith¹,

Saposnik²,

Biessels³

et al. 2017

Stroke

304

297

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Abstract-Two decades of epidemiological research shows that silent cerebrovascular disease is common and is associated with future risk for stroke and dementia. It is the most common incidental finding on brain scans. To summarize evidence on the diagnosis and management of silent cerebrovascular disease to prevent stroke, the Stroke Council of the American Heart Association convened a writing committee to evaluate existing evidence, to discuss clinical considerations, and to offer suggestions for future research on stroke prevention in patients with 3 cardinal manifestations of silent cerebrovascular disease: silent brain infarcts, magnetic resonance imaging white matter hyperintensities of presumed vascular origin, and cerebral microbleeds. The writing committee found strong evidence that silent cerebrovascular disease is a common problem of aging and that silent brain infarcts and white matter hyperintensities are associated with future symptomatic stroke risk independently of other vascular risk factors. In patients with cerebral microbleeds, there was evidence of a modestly increased risk of symptomatic intracranial hemorrhage in patients treated with thrombolysis for acute ischemic stroke but little prospective evidence on the risk of symptomatic hemorrhage in patients on anticoagulation. There were no randomized controlled trials targeted specifically to participants with silent cerebrovascular disease to prevent stroke. Primary stroke prevention is indicated in patients with silent brain infarcts, white matter hyperintensities, or microbleeds. Adoption of standard terms and definitions for silent cerebrovascular disease, as provided by prior American Heart Association/American Stroke Association statements and by a consensus group, may facilitate diagnosis and communication of findings from radiologists to clinicians. (Stroke. 2017;48:e44-e71.

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Section: Safety Of Intravenous Thrombolysis and Acute Ischemic Strokementioning

confidence: 99%

Prevention of Stroke in Patients With Silent Cerebrovascular Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

Smith¹,

Saposnik²,

Biessels³

et al. 2017

Stroke

304

297

View full text Add to dashboard Cite

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“…Collectively, these studies were composed of 1974 patients (study sample size range: 206–717), 480 (24.3%) of which had CMBs on pretreatment MRI scans. From inspection of each of the studies, patients with preexisting CMBs were older, 15 – 19 had a more severe degree of leukoaraiosis, 15 , 17 , 19 higher rate of diabetes mellitus, 17 , 19 and higher rate of hypertension (or higher systolic blood pressure), 16 , 18 , 19 whereas other baseline characteristics were not significantly different. The characteristics of CMBs are summarized in Table 3 .…”

Section: Resultsmentioning

confidence: 98%

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

Cai

Yan³

et al. 2015

Medicine

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It remains unclear whether preexisting cerebral microbleeds (CMBs) increase the risks of worse functional outcome after thrombolytic therapy. We performed a systematic review and meta-analysis to assess the risk of unfavorable outcome in patients with acute ischemic stroke and CMBs.We searched EMBASE, PubMed, and Web of Science for relevant studies assessing functional outcome in the patients with CMBs following thrombolytic therapy. Fixed-effects and random-effects models were performed.Five eligible studies including 1974 patients were pooled in meta-analysis. The prevalence of CMBs was 24.3%. The pooled analysis demonstrates odds ratio for preexisting CMBs and the achievement of favorable outcome to be 0.69 (95% CI 0.56–0.86; P = 0.001) with no evidence of statistical heterogeneity (I2 = 46.7%, P = 0.112).Our meta-analysis of available published data demonstrates an increased risk of worse functional outcome after thrombolytic therapy for acute ischemic stroke in patients with pre-existing CMBs. Future studies are needed to determine whether the risk outweigh the expected benefit of reperfusion therapies.

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“…On the 3.0T scanner, T2∗ GRE sequences were 5 mm slice thickness with slice spacing 6 mm (repetition time, 690 ms; echo time, 20 ms; field of view 240 mm; 30° flip angle; matrix size 320 × 210). 9 …”

Section: Methodsmentioning

confidence: 99%

“… 7 , 8 It is not clear whether CMBs are associated with hemorrhagic complications and mortality after mechanical thrombectomy. 9 …”

Section: Introductionmentioning

confidence: 99%

New Cerebral Microbleeds After Mechanical Thrombectomy for Large-Vessel Occlusion Strokes

et al. 2015

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The interval appearance of cerebral microbleeds (CMBs) after endovascular treatment has never been described. We investigated the frequency and predictors of new CMBs that developed shortly after mechanical thrombectomy for acute ischemic stroke, and its impact on clinical outcome.We retrospectively analyzed patients with large-vessel occlusion strokes treated with Merci Retriever, Penumbra System, or stent-retriever devices. Serial T2∗-weighted gradient-recall echo (GRE) magnetic resonance imaging (MRI) before and 48 h after endovascular thrombectomy were assessed to identify new CMBs. We examined independent factors associated with new CMBs after mechanical thrombectomy. We analyzed the association of the presence, burden, and distribution of new CMBs with clinical outcome.A total of 187 consecutive patients with serial GRE were enrolled in this study. CMBs were evident in 36 (19.3%) patients before mechanical thrombectomy. New CMBs occurred in 41 (21.9%) patients after mechanical thrombectomy. Of the 68 new CMBs, 45 appeared in the lobar location, 18 in the deep location and 5 in the infratentorial location. The presence of baseline CMBs was associated with new CMBs after mechanical thrombectomy (OR 5.38; 95% CI 2.13–13.59; P < 0.001), no matter whether the patients were treated primarily with mechanical thrombectomy or with intravenous thrombolysis followed by mechanical thrombectomy. Patients with new CMBs did not have increased rates of hemorrhagic transformation, in-hospital mortality, and modified Rankin Scale score 4 to 6 at discharge.New CMBs are common after mechanical thrombectomy in one-fifth of patients with acute ischemic stroke. Baseline CMBs before mechanical thrombectomy predicts the development of new CMBs. New CMBs after mechanical thrombectomy do not influence clinical outcome.

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Mechanical thrombectomy for acute ischemic stroke with cerebral microbleeds

Cited by 31 publications

References 28 publications

Prevention of Stroke in Patients With Silent Cerebrovascular Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

Prevention of Stroke in Patients With Silent Cerebrovascular Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

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

New Cerebral Microbleeds After Mechanical Thrombectomy for Large-Vessel Occlusion Strokes

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