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Abstract
Background and Purpose Cerebral microbleeds (CMBs) are generally considered markers of hemorrhagic and ischemic stroke and are predictors of hemorrhagic complications after a stroke. However, the potential impact of CMB presence and status on clinical outcomes after acute ischemic stroke (AIS) in patients treated with mechanical thrombolysis, the new standard of care for large vessel occlusion (LVO) stroke, remains controversial. The present study aimed to examine the association between pre-treatment CMBs and HT after successful recanalization by endovascular treatment (EVT) in patients with acute ischemic stroke due to LVO.
Methods This prospective cohort study included 132 patients with acute ischemic stroke who were successfully recanalized by EVT for emergent LVO. An expert neuroradiologist graded CMBs and HT on GRE T2 weighted MRI using a validated scale. The primary outcome was HT after EVT and the relationship between HT and the presence and burden of CMB was investigated. The secondary outcome was defined as poor functional outcome with modified Rankin Scale scores of 3 to 6 at 3 months.
Results Among 132 patients (mean age 66.9±13.9, male 68.9%), 24 (18.2%) had CMBs and 59 (44.4%) had HT. Sixty-five patients (49.2%) had a poor functional outcome, and the mortality rate was 9.5%. There was statistically significant association between the presence of CMB and HT after EVT in patients with successful recanalization (70.8% vs. 38.9%; P=0.004). Moreover, the number of CMBs (≥5) was significantly related to HT after EVT (P=0.003). The presence of CMBs was associated with poor functional outcomes (75.0% vs. 44.4%; P=0.017). However, there was no association between the presence of CMBs and mortality (12.5% vs. 12.0%; P= 0.963). In multiple logistic regression for HT after successful EVT, only CMB was showed with the statical significance (p =0.035) in contrast with the other factor such atrial fibrillation, previous use of anticoagulant, poor outcome related to HT after EVT.
Conclusions These findings suggest that the presence of CMBs is associated with HT and poor functional outcome following EVT and had no effect on mortality in patients with successful endovascular recanalization. However, CMBs do not show such a high impact on HT as other literature in our study. Therefore, it seems appropriate to consider CMB status in individual risk stratification of poor clinical outcome following recanalization by EVT with AIS. Future large and well-designed prospective studies are required to better characterize the underlying factors behind CMB-associated clinical deterioration.
Disclosures S. Chung: None. J. Kim: None.