Pretreatment cerebral microbleeds and symptomatic intracerebral hemorrhage post-thrombolysis: a systematic review and meta-analysis

Yan, Jiangzhi; Qiu, Jianting; Wu, Xiumei; Ge, Yong-gui; Wang, Jian; Wang, Yujie

doi:10.1007/s00415-018-9156-5

Cited by 8 publications

(4 citation statements)

References 21 publications

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“…The recent meta-analysis by Yan et al of 2,407 participants from nine studies showed that pretreatment CMBs were associated with increased incidence of sICH in AIS patients receiving IVT. However, these results were not convincing enough to establish the presence of a CMB as a contraindication to IVT [74].…”

Section: Iv-thrombolysismentioning

confidence: 76%

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

Wach-Klink

Iżycka‐Świeszewska

Kozera

et al. 2021

Neurol Neurochir Pol.

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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.

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Section: Iv-thrombolysismentioning

confidence: 76%

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

Wach-Klink

Iżycka‐Świeszewska

Kozera

et al. 2021

Neurol Neurochir Pol.

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“… 33 Other meta-analyses on CMBs have shown a significantly higher risk of sHT and poor functional outcomes associated with CMBs, especially when the CMB burden is high. 34 – 36 Multiple hemorrhages/microbleeds, similar to prior history of ICrH, might signify an underlying vascular pathology, which increases the risk for severe stroke, poor functional outcomes, and the susceptibility to developing sHT. 37 It is noteworthy that small vessel diseases, including CMBs, white matter hyperintensities, lacunae, and cerebral amyloid angiopathy, are recognized to contribute to the occurrence of spontaneous ICH.…”

Section: Discussionmentioning

confidence: 99%

Intravenous thrombolysis in ischemic stroke patients with a prior intracranial hemorrhage: a meta-analysis

Dolatshahi

Sabahi

Shahjouei

et al. 2022

Ther Adv Neurol Disord

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Background: The history of intracranial hemorrhage (ICrH) is considered a contraindication for intravenous thrombolysis (IVT) among patients with acute ischemic stroke (AIS). Objective: This study aimed at comparing the safety of IVT among patients with and without a history of ICrH. Methods: We performed a systematic review of the literature. Data regarding all AIS patients with prior ICrH who received IVT were retrieved. Meta-analysis was performed to compare the rate of symptomatic hemorrhagic transformation (sHT), death within 90 days, and favorable and unfavorable 90-day functional outcomes based on modified Rankin Scale (mRS) among stroke patients with and without prior ICrH. Results: Out of 13,032 reviewed records, 7 studies were included in the systematic review and meta-analysis. Quantitative synthesis of data regarding the rate of sHT (5068 patients) revealed no significant difference between the two groups [odds ratio, OR: 1.55 (0.77, 3.12); p = 0.22]. However, a significantly higher risk of death within 90 days [OR: 3.91 (2.16, 7.08); p < 0.00001] and a significantly higher 90-day poor functional outcomes (mRS, 4–6) [OR: 1.57 (1.07, 2.30); p = 0.02] were observed among patients with prior ICrH. Likewise, the percentage of 90-day good functional outcomes (mRS, 0–1) was lower in the prior ICrH group [OR: 0.54 (0.35, 0.84); p = 0.06]. Subgroup analyses in patients with a history of ICrH (based on both patients’ medical history and imaging confirmation) revealed no significant between-group differences in rates of sHT. Also, sensitivity analysis consisting of only studies using standard-dose IVT showed no difference in sHT rates and 90-day outcomes between the two groups. There was no evidence of heterogeneity ( I2 >50%) among included studies. Conclusion: The results of this study indicated that prior history of ICrH does not increase the risk of sHT post-IVT, but it is associated with a higher risk of death and poor functional outcomes in 90 days.

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“…Computed tomography or MRI features can provide important information for thrombolysis, and cSVD is an important risk factor for poor function after thrombolysis. Previous studies focused on the impact of a single cSVD on the prognosis of thrombolytic patients 28,29 . However, recently, many researchers believe it may be more meaningful to discuss the relationship between the global burden of cSVD and cerebral infarction because multiplex cSVDs may coexist 11 .…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies focused on the impact of a single cSVD on the prognosis of thrombolytic patients. 28,29 However, recently, many researchers believe it may be more meaningful to discuss the relationship between the global burden of cSVD and cerebral infarction because multiplex cSVDs may coexist. 11 Our analysis shows that patients with cSVD scores of 2 points or greater have an increased incidence of poor function, which is similar to the findings of previous studies.…”

Section: Cerebral Small Vessel Disease Scorementioning

confidence: 99%

A Novel Nomogram for Predicting Poor 6-Month Function in Patients With Acute Ischemic Stroke Receiving Thrombolysis

Huang

et al. 2021

J Cardiovasc Nurs

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BackgroundPatients with acute ischemic stroke (AIS) receiving thrombolysis with good function at discharge are usually ignored. Their functional deterioration after discharge not only compromises the effectiveness of thrombolytic therapy but also reduces their long-term quality of life, which is not conducive to the advancement of medical healthcare and continuing care.ObjectiveThe aims of this study were to explore the risk factors for poor 6-month function in patients with AIS receiving thrombolysis with good function at discharge and construct a novel nomogram model.MethodsThis case-control study retrospectively analyzed the medical data of 149 patients with AIS receiving thrombolysis with good function at discharge from January 2017 to June 2019. Patients were divided into a poor function group (<3 points) and a good function group (≥3 points) according to their modified Rankin Scale scores at 6 months. Logistic regression was used to identify risk factors for poor 6-month function. A novel nomogram prediction model for poor 6-month function was constructed, and its prediction performance and concordance were evaluated.ResultsOf 149 patients, 21 (14%) had poor 6-month function and 128 (86%) had good 6-month function. Multivariate regression analysis showed that physical inactivity, neutrophil count, cerebral small vessel disease score, and hospitalization days were independent risk factors for poor 6-month function. A regression model was established according to the multivariate analysis, and the area under the curve was 0.9363. The accuracy was 71.99%, the sensitivity was 78.83%, and the specificity was 70.26%. A nomogram model was constructed, and its concordance index was 0.836 after internal validation.ConclusionThe novel nomogram model facilitates risk prediction of poor 6-month function in patients with AIS receiving thrombolysis with good function at discharge and is helpful for making discharge plans.

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Pretreatment cerebral microbleeds and symptomatic intracerebral hemorrhage post-thrombolysis: a systematic review and meta-analysis

Cited by 8 publications

References 21 publications

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

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

Intravenous thrombolysis in ischemic stroke patients with a prior intracranial hemorrhage: a meta-analysis

A Novel Nomogram for Predicting Poor 6-Month Function in Patients With Acute Ischemic Stroke Receiving Thrombolysis

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