Abstract
ObjectivesAim of this study was to evaluate the association between cerebral microbleeds (CMBs) and white matter disease (WMD) with intracerebral hemorrhage (ICH) after intravenous thrombolysis (IVT) with rt-PA. We also evaluated whether CMBs characteristics and WMD burden correlate with symptomatic ICH and outcome.MethodsWe included acute ischemic stroke (AIS) patients treated with IVT. The number and location of CMBs as well as severity of WMD were rated analyzing pre- or post-treatment MRI. Multivariable regression analysis was used to determine the impact of CMB and WMD on ICH subgroups and outcome measures.Results434 patients were included. CMBs were detected in 23.3% of them. ICH occurred in 34.7% of patients with CMBs. Independent predictors of parenchymal hemorrhage were the presence of CMBs (OR 2.724, 95% CI 1.360–5.464, p = 0.005) as well as cortical-subcortical stroke (OR 3.629, 95% CI 1.841–7.151, p < 0.001) and atherothrombotic stroke subtype (OR 3.381, 95% CI 1.335–8.566, p = 0.010). Either the presence, or number, and location of CMBs, as well as WMD, was not independently associated with the development of SICH. No independent association between the presence, number, or location of CMBs or WMD and outcome measures was observed.ConclusionsThe results of our study suggest that the exclusion of eligible candidates to administration of IV rt-PA only on the basis of CMBs presence is not justified. The clinical decision should be weighed with a case-by-case approach. Additional data are needed to evaluate the benefit-risk profile of rt-PA in patients carrying numerous microbleeds.
Highlights
Electronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.Neurosciences, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy 3 Department of Clinical and Sperimental Medicine, University of Pisa, Pisa, Italy 4 Stroke Unit and Division of Internal and Cardiovascular Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, ItalyCerebral microbleeds (CMBs) are the expression of cerebral small vessel disease (SVD) and are commonly found in the elderly population, including patients with acute ischemic stroke (AIS) undergoing intravenous thrombolysis (IVT) [1]
Patients with AIS receiving IVT according to the current guidelines [5] and undergoing magnetic resonance imaging (MRI) before or within 24 h after rt-PA infusion in two stroke centers were included in the study
The majority of patients underwent MRI after IVT within 24 h of stroke onset, while only in 19% of patients MRI was performed before IVT
Summary
Cerebral microbleeds (CMBs) are the expression of cerebral small vessel disease (SVD) and are commonly found in the elderly population, including patients with acute ischemic stroke (AIS) undergoing intravenous thrombolysis (IVT) [1]. If CMBs represent a risk for the development of symptomatic intracerebral hemorrhage (SICH), or predict worse outcome after IVT in AIS, is a matter of debate. Another neuroimaging marker of SVD that could be in relation to the risk of ICH is white matter disease (WMD). Some evidence suggests that it can increase the risk of ICH during IVT but, so far, it Neurol Sci (2021) 42:1969–1976 does not represent an absolute exclusion criterion [3]. No clear leukoaraiosis volume threshold has been identified below in which no benefit or harm of IVT could be observed [4]
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