Abstract
Objective: This investigation aimed at studying the prevalence of cerebral microbleeds (CMBs), including risk factors and the correlation of CMBs to ischemic stroke (IS) patient end results.Methods: Four hundred and fifty-nine acute IS cases were recruited between April 2014 and December 2016. Cerebral microbleeds were analyzed using susceptibility-weighted imaging (SWI) brain MRI scan. The enrolled patients with acute IS were followed up for 12–24 months, with a median follow-up time of 19 months. The follow-up endpoint events including recurrent ischemic stroke (RIS), intracranial hemorrhage (ICH), transient ischemic attack (TIA), mortality, and cardiovascular events. The associations between vascular risk factors and CMBs in IS patients were analyzed using univariate and multivariate logistic regression analysis. Cox regression model was employed for evaluating CMB impact on clinical outcome.Results: Among 459 enrolled patients, 187 (40.7%) had CMBs and 272 (59.2%) had no CMB. In comparison with patients with no CMBs, age was higher and hypertension was more frequent in patients with CMBs. Multivariate logistic regression analyses revealed age and hypertension were independently associated with the presence of CMBs. Among the patient cohort, 450 cases completed the follow-up. During the follow-up period, 22 (4.9%) of patients developed ICH, 12 (2.7%) developed TIA, 68 (15.1%) developed RIS, cardiovascular events occurred in 20 (4.44%), and 13 (2.89%) cases were mortalities. Compared with patients without CMBs, IS patients with CMBs have an increased prevalence of ICH (p < 0.05). However, no statistically valid variations regarding other outcome incidences between both groups was identified (p > 0.05). The incidence of ICH was elevated in tandem with elevations in number of CMBs. Following adjusting for age, multivariate Cox proportional-hazards regression analysis revealed that CMBs ≥10 were independent predictors of ICH in acute IS patients.Conclusion: Age and hypertension are independently associated with the presence of CMBs. Intracranial hemorrhage incidence rate was increased with the number of CMBs, and the number of CMBs ≥10 were independent predictors of ICH in acute stroke patients.
Highlights
The concept of cerebral microbleeds (CMBs) was first proposed in the mid-1990s, and it is caused by the deposition of hemosiderin in the brain caused by the leakage of red blood cells from small blood vessels [1]
Recent systematic reviews demonstrated that increased number of CMBs are linked to exacerbated risks for intracranial hemorrhage/ischemic stroke (ICH/IS), and the presence of CMBs may play a key role in vascular cognitive impairment [4, 5]
Multivariate logistic stepwise regression analyses revealed age and hypertension to be independently associated with the presence of CMBs in IS patients
Summary
The concept of cerebral microbleeds (CMBs) was first proposed in the mid-1990s, and it is caused by the deposition of hemosiderin in the brain caused by the leakage of red blood cells from small blood vessels [1]. It is one of the typical imaging manifestations of cerebral small vessel diseases [2]. Magnetic resonance gradient echo T2-weighted imaging (T2∗ WI) (GE-T2∗ WI) is a highly sensitive technique for detecting CMBs, which can detect hemosiderin deposition (of several millimeters in size) within the brain parenchyma. According to the number of detected CMBs, they are divided into grade 0 (none), grade 1 (CMBs: 1–4), grade 2 (CMBs: 5–9), and grade 3 (CMs ≥10) [9]
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