Pre-treatment cerebral microbleeds and intracranial hemorrhage in patients with ischemic stroke receiving endovascular therapy: a systematic review and meta-analysis

Wu, Xiumei; Yan, Jiangzhi; Ye, Huirong; Qiu, Jianting; Wang, Jian; Wang, Yujie

doi:10.1007/s00415-019-09210-6

Cited by 10 publications

(10 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…118 119 A recent meta-analysis including 598 patients with large vessel occlusion treated with endovascular reperfusion therapy reported that the pooled relative risk of ICH was 0.90 (95% CI 0.65 to 1.25) in patients with CMBs (18% of included patients) versus those without CMBs. 120 In view of these considerations, it is recommended that CMB presence or burden should not represent an exclusion criterion for mechanical thrombectomy in patients with large vessel occlusion.…”

Section: Reperfusion Therapies For Acute Is and Cmbsmentioning

confidence: 99%

Cerebral microbleeds: from depiction to interpretation

Puy

Pasi

Rodrigues

et al. 2021

J Neurol Neurosurg Psychiatry

View full text Add to dashboard Cite

Cerebral microbleeds (CMBs) are defined as hypointense foci visible on T2*-weighted and susceptible-weighted MRI sequences. CMBs are increasingly recognised with the widespread use of MRI in healthy individuals as well as in the context of cerebrovascular disease or dementia. They can also be encountered in major critical medical conditions such as in patients requiring extracorporeal mechanical oxygenation. The advent of MRI-guided postmortem neuropathological examinations confirmed that, in the context of cerebrovascular disease, the vast majority of CMBs correspond to recent or old microhaemorrhages. Detection of CMBs is highly influenced by MRI parameters, in particular field strength, postprocessing methods used to enhance T2* contrast and three dimensional sequences. Despite recent progress, harmonising imaging parameters across research studies remains necessary to improve cross-study comparisons. CMBs are helpful markers to identify the nature and the severity of the underlying chronic small vessel disease. In daily clinical practice, presence and numbers of CMBs often trigger uncertainty for clinicians especially when antithrombotic treatments and acute reperfusion therapies are discussed. In the present review, we discuss those clinical dilemmas and address the value of CMBs as diagnostic and prognostic markers for future vascular events.

show abstract

Section: Reperfusion Therapies For Acute Is and Cmbsmentioning

confidence: 99%

Cerebral microbleeds: from depiction to interpretation

Puy

Pasi

Rodrigues

et al. 2021

J Neurol Neurosurg Psychiatry

View full text Add to dashboard Cite

show abstract

“…CMBs were present in 18%, and ≥ 5 CMBs in only 1% of patients. The risk of ICH after EVT did not significantly differ between patients with and without CMBs [77].…”

Section: Endovascular Thrombectomy (Evt)mentioning

confidence: 71%

Cerebral microbleeds in neurological practice: concepts, diagnostics and clinical aspects

Wach-Klink

Iżycka‐Świeszewska

Kozera

et al. 2021

Neurol Neurochir Pol.

View full text Add to dashboard Cite

Introduction: Due to the widespread use of magnetic resonance imaging (MRI) in neurological diagnostics, the number of patients detected as having cerebral microbleeds (CMBs) continues to increase. However, their clinical impact still remains controversial, especially the question of whether CMBs significantly increase the risk of life-threatening intracerebral haemorrhage (ICH) in patients undergoing intravenous thrombolysis (IVT) or endovascular thrombectomy (EVT), or in patients on anticoagulant therapy or statins. State of the art:The term 'CMB' is a radiological concept that aims to illustrate microscopic pathology of perivascular hemosiderin deposits corresponding most probably to small foci of past bleeding. MRI images in sequence T2*-GRE and susceptibility-weighted imaging (SWI) are used for a diagnosis of a CMB. This review summarises the current knowledge regarding the definition, prevalence, genetics, risk factors, radiological diagnosis and differential diagnosis of a CMB. We discuss its role as an indicator of future ischaemic or haemorrhagic events in high risk patients or those on antiplatelet or anticoagulant therapy, and its prognostic value for reperfusion strategies and for the development of dementia. Future direction: The place of CMBs in current guidelines is explored herein. It must be emphasised that the recommendations relating to CMBs are expert opinions. Therefore, at the end of this review, we pose a number of questions that future clinical trials should answer.

show abstract

“…However, advances in endovascular treatment methods and MR imaging methods may be the cause of the different results. Results of a recent meta-analysis involving 598 patients regarding the association between post-mechanical thrombectomy hemorrhagic complications and CMBs 13 did not show a positive association. When we take a closer look into the studies analyzed, a previous study including Asian patients from 2002 to 2012 using 1.5T MRI GRE failed to show an association between CMB burden and hemorrhagic complications.…”

Section: Discussionmentioning

confidence: 88%

“…In this regard, it is of value to evaluate whether the presence of CMBs is associated with the risk of hemorrhagic complications after mechanical thrombectomy. Unfortunately, there is currently only limited literature addressing the safety of mechanical thrombectomy in patients with CMBs at presentation; moreover, meta-analyses have included only a small number of patients 13 .…”

Section: Introductionmentioning

confidence: 99%

Influence of cerebral microbleeds on mechanical thrombectomy outcomes

Lee

Hwang

Choi

et al. 2022

Sci Rep

View full text Add to dashboard Cite

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.

show abstract

Pre-treatment cerebral microbleeds and intracranial hemorrhage in patients with ischemic stroke receiving endovascular therapy: a systematic review and meta-analysis

Cited by 10 publications

References 26 publications

Cerebral microbleeds: from depiction to interpretation

Cerebral microbleeds: from depiction to interpretation

Cerebral microbleeds in neurological practice: concepts, diagnostics and clinical aspects

Influence of cerebral microbleeds on mechanical thrombectomy outcomes

Contact Info

Product

Resources

About