RT Journal Article
SR Electronic
T1 Mechanical thrombectomy for acute ischemic stroke with cerebral microbleeds
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 563
OP 567
DO 10.1136/neurintsurg-2015-011765
VO 8
IS 6
A1 Zhong-Song Shi
A1 Gary R Duckwiler
A1 Reza Jahan
A1 Satoshi Tateshima
A1 Nestor R Gonzalez
A1 Viktor Szeder
A1 Jeffrey L Saver
A1 Doojin Kim
A1 Latisha K Ali
A1 Sidney Starkman
A1 Paul M Vespa
A1 Noriko Salamon
A1 J Pablo Villablanca
A1 Fernando Viñuela
A1 Lei Feng
A1 Yince Loh
A1 David S Liebeskind
YR 2016
UL http://jnis.bmj.com/content/8/6/563.abstract
AB 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.