Risk of Intracerebral Hemorrhage in Patients With Cerebral Microbleeds Undergoing Endovascular Intervention

Abstract

Background and Purpose-Cerebral microbleeds (CMBs) on MRI gradient echo images are hemosiderin deposits, which may predict intracerebral hemorrhage (ICH). The risk of ICH in patients with CMBs could be exacerbated by the use of antithrombotics. The purpose of our study is to prospectively evaluate the risk of ICH in patients with ischemic stroke who receive dual antiplatelet therapy for endovascular intervention. Methods-We analyzed MRI of 133 patients admitted consecutively for intra-and extracranial stenting for symptomatic large artery atherosclerosis who received aspirin and clopidogrel. Quantity and location of CMBs were recorded by neuroradiologists independent from the angioplasty team. The primary end point was symptomatic ICH as evident in CT of the brain within 12 weeks of procedure. Results-CMBs were identified in 23 patients. Mean number of CMBs was 2.3Ϯ1.6. Four patients had Ͼ5 CMBs.Forty-seven patients had intracranial stents, 84 patients had extracranial stents, and 2 patients had both intracranial and extracranial stents. There was no difference in risk of symptomatic ICH between those with (4.3%) and without CMBs (5.5%) patient with CMBs (Pϭ1.000). Conclusions-The presence of a small number of CMBs does not cause a large increase in the short-term risk of symptomatic ICH in patients with ischemic stroke who undergo endovascular intervention with dual antiplatelet therapy.

Cerebral Microbleeds

“…17 In patients with CMBs, the number of CMBs is usually positively skewed with a wide range (1-93 per person in ischemic stroke cohort), 18 meaning that the majority of people have only 1 or 2 CMBs and only a small portion of patients have ≥5 CMBs (17.4% in ischemic stroke patients with CMBs). 19 Overall, CMBs are not uncommonly found in subjects with ischemic stroke/TIA, who require antithrombotic therapy. At least about a quarter of these subjects harbor CMBs.…”

Mechanical thrombectomy for acute ischemic stroke with cerebral microbleeds

“…However, patients with multiple CMBs had an increased post-thrombolytic bleeding risk 11. The negative effect of a small number of CMBs on the intracranial bleeding risk is also supported by a study of intracranial and extracranial stenting for 133 patients with symptomatic large artery atherosclerosis 26. These results suggest that a small number of CMBs does not increase the risk of intracranial hemorrhage after IV thrombolysis, mechanical thrombectomy, and intracranial stenting.…”

Antiplatelet therapy may be safe in ischemic stroke patients with cerebral microbleed

“…One study showed that dual antiplatelet therapy was beneficial after endovascular intervention in patients with CMB. 7 Another study revealed that for ischemic stroke patients taking antiplatelet agents, CMB did not increase the risk of cerebral hemorrhage. 11 Even for patients with more than four CMBs, antiplatelet therapy still should be continued in the first year after ischemic stroke.…”