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Original research
Mechanical thrombectomy for acute ischemic stroke with cerebral microbleeds
  1. Zhong-Song Shi1,
  2. Gary R Duckwiler2,
  3. Reza Jahan2,
  4. Satoshi Tateshima2,
  5. Nestor R Gonzalez2,3,
  6. Viktor Szeder1,
  7. Jeffrey L Saver4,
  8. Doojin Kim4,
  9. Latisha K Ali4,
  10. Sidney Starkman4,5,
  11. Paul M Vespa3,
  12. Noriko Salamon6,
  13. J Pablo Villablanca6,
  14. Fernando Viñuela2,
  15. Lei Feng7,
  16. Yince Loh8,
  17. David S Liebeskind4,9
  1. 1Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
  2. 2Division of Interventional Neuroradiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
  3. 3Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
  4. 4Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
  5. 5Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
  6. 6Division of Diagnostic Neuroradiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
  7. 7Department of Radiology, Kaiser Permanente Medical Center, Los Angeles, California, USA
  8. 8Interventional Neuroradiology and Neurocritical Care Services, Madigan Army Medical Center, Tacoma, Washington, USA
  9. 9Neurovascular Imaging Research Core, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
  1. Correspondence to Dr Zhong-Song Shi, Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Second Ave, Guangzhou 510080, China; shizhs{at}mail.sysu.edu.cn

Abstract

Background The influence of cerebral microbleeds (CMBs) on post-thrombolytic hemorrhagic transformation (HT) in patients with acute ischemic stroke remains controversial.

Objective To investigate the association of CMBs with HT and clinical outcomes among patients with large-vessel occlusion strokes treated with mechanical thrombectomy.

Methods We analyzed patients with acute stroke treated with Merci Retriever, Penumbra system or stent-retriever devices. CMBs were identified on pretreatment T2-weighted, gradient-recall echo MRI. We analyzed the association of the presence, burden, and distribution of CMBs with HT, procedural complications, in-hospital mortality, and clinical outcome.

Results CMBs were detected in 37 (18.0%) of 206 patients. Seventy-three foci of microbleeds were identified. Fourteen patients (6.8%) had ≥2 CMBs, only 1 patient had ≥5 CMBs. Strictly lobar CMBs were found in 12 patients, strictly deep CMBs in 12 patients, strictly infratentorial CMBs in 2 patients, and mixed CMBs in 11 patients. There were no significant differences between patients with CMBs and those without CMBs in the rates of overall HT (37.8% vs 45.6%), parenchymal hematoma (16.2% vs 19.5%), procedure-related vessel perforation (5.4% vs 7.1%), in-hospital mortality (16.2% vs 18.3%), and modified Rankin Scale score 0–3 at discharge. CMBs were not independently associated with HT or in-hospital mortality in patients treated with either thrombectomy or intravenous thrombolysis followed by thrombectomy.

Conclusions Patients with CMBs are not at increased risk for HT and mortality following mechanical thrombectomy for acute stroke. Excluding such patients from mechanical thrombectomy is unwarranted. The risk of HT in patients with ≥5 CMBs requires further study.

  • Stroke
  • Thrombectomy
  • Hemorrhage

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