Preexisting Cerebral Microbleeds on Susceptibility-Weighted Magnetic Resonance Imaging and Post-Thrombolysis Bleeding Risk in 392 Patients
Preexisting Cerebral Microbleeds on Susceptibility-Weighted Magnetic Resonance Imaging and Post-Thrombolysis Bleeding Risk in 392 Patients
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DOI：
10.1161/strokeaha.114.004796
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发表时间：
2014-06-01
期刊：
影响因子：
8.3
通讯作者：
Jung, Simon
中科院分区：
文献类型：
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作者：
Gratz, Pascal P.;El-Koussy, Marwan;Jung, Simon
背景和目的：急性卒中中MRI上可见的脑微出血（CMB）是否会增加脑内出血（ICH）的风险或溶栓后更差的结局，这一问题尚未得到解决。本研究的目的是分析预处理磁共振成像检测到的CMB对ICH发生率和outcome. Methods的影响，从2010年到2013年，我们治疗了724例患者静脉溶栓，血管内治疗，或静脉溶栓后血管内治疗。在724例患者中，共有392例在治疗前接受了磁共振成像检查。对CMB进行回顾性评级。多变量回归分析被用来确定CMB对ICH和outcome.Results-Of 392例患者的影响，174与静脉溶栓治疗，150与血管内治疗，68与静脉溶栓血管内治疗。在79例（20.2%）患者中检测到CMB。症状性脑出血21例（5.4%），无症状性脑出血75例（19.1%），其中脑梗死灶内出血61例（15.6%），脑梗死灶外出血35例（8.9%）。CMB的存在、其负荷、主要部位及其假定的发病机制均不影响有症状或无症状ICH的风险。较高的CMB负荷轻微增加了梗死区以外的ICH风险（P=0.048;比值比，1.004; 95%置信区间，1.000-1.008）。结论-治疗前磁共振成像检测到的CMB并没有增加ICH风险或恶化预后，即使考虑到CMB负荷、主要部位或推测的发病机制。在梗死区以外，随着CMB负荷的增加，ICH的风险仅略有增加，因此不建议对此类患者进行溶栓治疗。
Background and Purpose-The question whether cerebral microbleeds (CMBs) visible on MRI in acute stroke increase the risk for intracerebral hemorrhages (ICHs) or worse outcome after thrombolysis is unresolved. The aim of this study was to analyze the impact of CMB detected with pretreatment susceptibility-weighted MRI on ICH occurrence and outcome.Methods-From 2010 to 2013 we treated 724 patients with intravenous thrombolysis, endovascular therapy, or intravenous thrombolysis followed by endovascular therapy. A total of 392 of the 724 patients were examined with susceptibility-weighted MRI before treatment. CMBs were rated retrospectively. Multivariable regression analysis was used to determine the impact of CMB on ICH and outcome.Results-Of 392 patients, 174 were treated with intravenous thrombolysis, 150 with endovascular therapy, and 68 with intravenous thrombolysis followed by endovascular therapy. CMBs were detected in 79 (20.2%) patients. Symptomatic ICH occurred in 21 (5.4%) and asymptomatic in 75 (19.1%) patients, thereof 61 (15.6%) bleedings within and 35 (8.9%) outside the infarct. Neither the existence of CMB, their burden, predominant location nor their presumed pathogenesis influenced the risk for symptomatic or asymptomatic ICH. A higher CMB burden marginally increased the risk for ICH outside the infarct (P=0.048; odds ratio, 1.004; 95% confidence interval, 1.000-1.008).Conclusions-CMB detected on pretreatment susceptibility-weighted MRI did not increase the risk for ICH or worsen outcome, even when CMB burden, predominant location, or presumed pathogenesis was considered. There was only a small increased risk for ICH outside the infarct with increasing CMB burden that does not advise against thrombolysis in such patients.