From the Department of Diagnostic and Interventional Neuroradiology (P.P.G., M.E.-K., K.H., C.Z., G.S., J.G., S.J.) and Department of Neurology (S.v.A., M.-L.M., M.R.H., U.F., H.P.M., M.A., S.J.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
Stroke. 2014 Jun;45(6):1684-8. doi: 10.1161/STROKEAHA.114.004796. Epub 2014 Apr 17.
The question whether cerebral microbleeds (CMBs) visible on MRI in acute stroke increase the risk for intracerebral hemorrhages (ICHs) or worse outcome after thrombolysis is unresolved. The aim of this study was to analyze the impact of CMB detected with pretreatment susceptibility-weighted MRI on ICH occurrence and outcome.
From 2010 to 2013 we treated 724 patients with intravenous thrombolysis, endovascular therapy, or intravenous thrombolysis followed by endovascular therapy. A total of 392 of the 724 patients were examined with susceptibility-weighted MRI before treatment. CMBs were rated retrospectively. Multivariable regression analysis was used to determine the impact of CMB on ICH and outcome.
Of 392 patients, 174 were treated with intravenous thrombolysis, 150 with endovascular therapy, and 68 with intravenous thrombolysis followed by endovascular therapy. CMBs were detected in 79 (20.2%) patients. Symptomatic ICH occurred in 21 (5.4%) and asymptomatic in 75 (19.1%) patients, thereof 61 (15.6%) bleedings within and 35 (8.9%) outside the infarct. Neither the existence of CMB, their burden, predominant location nor their presumed pathogenesis influenced the risk for symptomatic or asymptomatic ICH. A higher CMB burden marginally increased the risk for ICH outside the infarct (P=0.048; odds ratio, 1.004; 95% confidence interval, 1.000-1.008).
CMB detected on pretreatment susceptibility-weighted MRI did not increase the risk for ICH or worsen outcome, even when CMB burden, predominant location, or presumed pathogenesis was considered. There was only a small increased risk for ICH outside the infarct with increasing CMB burden that does not advise against thrombolysis in such patients.
急性脑卒中患者 MRI 显示的脑微出血（CMB）是否会增加颅内出血（ICH）或溶栓后预后不良的风险尚未明确。本研究旨在分析预处理磁共振磁敏感加权成像（SWI）检测到的 CMB 对 ICH 发生和结局的影响。
2010 年至 2013 年，我们对 724 例接受静脉溶栓、血管内治疗或静脉溶栓后血管内治疗的患者进行了治疗。724 例患者中有 392 例行 SWI 检查。CMB 采用回顾性评分。多变量回归分析用于确定 CMB 对 ICH 和结局的影响。
392 例患者中，174 例行静脉溶栓治疗，150 例行血管内治疗，68 例行静脉溶栓后血管内治疗。79 例（20.2%）患者检测到 CMB。症状性 ICH 发生 21 例（5.4%），无症状性 ICH 发生 75 例（19.1%），其中 61 例（15.6%）出血位于梗死灶内，35 例（8.9%）出血位于梗死灶外。CMB 的存在、负荷、主要部位或假定发病机制均不影响症状性或无症状性 ICH 的风险。CMB 负荷较高，仅使梗死灶外 ICH 的风险略有增加（P=0.048；比值比，1.004；95%置信区间，1.000-1.008）。
即使考虑 CMB 负荷、主要部位或假定发病机制，预处理 SWI 检测到的 CMB 并未增加 ICH 或恶化预后的风险。CMB 负荷增加仅使梗死灶外 ICH 的风险略有增加，这并不反对此类患者进行溶栓治疗。
