Pascal P Gratz1, Marwan El-Koussy1, Kety Hsieh1, Sebastian von Arx1, Marie-Luise Mono1, Mirjam Rachel Heldner1, Urs Fischer1, Heinrich P Mattle2, Christoph Zubler1, Gerhard Schroth1, Jan Gralla1, Marcel Arnold1, Simon Jung1. 1. From the Department of Diagnostic and Interventional Neuroradiology (P.P.G., M.E.-K., K.H., C.Z., G.S., J.G., S.J.) and Department of Neurology (S.v.A., M.-L.M., M.R.H., U.F., H.P.M., M.A., S.J.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland. 2. From the Department of Diagnostic and Interventional Neuroradiology (P.P.G., M.E.-K., K.H., C.Z., G.S., J.G., S.J.) and Department of Neurology (S.v.A., M.-L.M., M.R.H., U.F., H.P.M., M.A., S.J.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland. heinrich.mattle@insel.ch.
Abstract
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.
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.
Authors: Norbert Nighoghossian; Fatima Abbas; Tae-Hee Cho; Ana Filipa Geraldo; Vincent Cottaz; Elie Janecek; Laura Mechtouff; Magali Bischoff; Carlos El Khoury; Anne Marie Schott; Laurent Derex; Marc Hermier; Louis Guy Tisserand; Roxana Amelie; Leila Chamard; Yves Berthezene Journal: Neuroradiology Date: 2016-07-22 Impact factor: 2.804
Authors: Pascal P Klinger-Gratz; Gerhard Schroth; Jan Gralla; Simon Jung; Christian Weisstanner; Rajeev K Verma; Pasquale Mordasini; Frauke Kellner-Weldon; Kety Hsieh; Mirjam R Heldner; Urs Fischer; Marcel Arnold; Heinrich P Mattle; Marwan El-Koussy Journal: Neuroradiology Date: 2015-08-29 Impact factor: 2.804
Authors: Julia Meisterernst; Pascal P Klinger-Gratz; Lars Leidolt; Matthias F Lang; Gerhard Schroth; Pasquale Mordasini; Mirjam R Heldner; Marie-Luise Mono; Rebekka Kurmann; Monika Buehlmann; Urs Fischer; Marcel Arnold; Jan Gralla; Heinrich P Mattle; Marwan El-Koussy; Simon Jung Journal: PLoS One Date: 2017-09-28 Impact factor: 3.240
Authors: Junfeng Liu; Deren Wang; Yao Xiong; Bian Liu; Chenchen Wei; Zhenxing Ma; Bo Wu; Ruozhen Yuan; Hehan Tang; Ming Liu Journal: Medicine (Baltimore) Date: 2016-06 Impact factor: 1.889