Chacon-Portillo Martin A, Llinas Rafael H, Marsh Elisabeth B
Division of Congenital Heart Surgery, Texas Children's Hospital, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.
Department of Neurology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 446, Baltimore, MD, 21287, USA.
BMC Neurol. 2018 Mar 27;18(1):33. doi: 10.1186/s12883-018-1029-0.
Intravenous tissue plasminogen activator (IV tPA) after acute ischemic stroke carries the risk of symptomatic intracerebral hemorrhage (sICH). Cerebral microbleeds (CMBs) may indicate increased risk of hemorrhage and can be seen on magnetic resonance imaging (MRI). In this study, we examined the association between CMBs and sICH, focusing on the predictive value of their presence, burden, and location.
Records from all patients presenting to two academic stroke centers with acute ischemic stroke treated with IV tPA over a 5-year period were retrospectively reviewed. Demographic, medical, and imaging variables were evaluated. The presence, number, and location (lobar vs nonlobar) of CMBs were noted on gradient echo MRI sequences obtained during the admission. Univariable and multivariable statistical models were used to determine the relationship between CMBs and hemorrhagic (symptomatic and asymptomatic) transformation.
Of 292 patients (mean age 62.8 years (SD 15.3), 49% African-American, 52% women), 21% (n = 62) had at least one CMB, 1% (n = 3) had > 10 CMBs, and 1% (n = 3) were diagnosed with probable cerebral amyloid angiopathy. After treatment, 16% (n = 46) developed hemorrhagic transformation, of which 6 (2%) were sICH. There was no association between CMB presence (p = .135) or location (p = .325) with sICH; however, those with a high CMB burden (> 10 CMB) were more likely to develop sICH (OR 37.8; 95% CI: 2.7-539.3; p = .007).
Our findings support prior findings that a high CMB burden (> 10) in patients with acute stroke treated with IV tPA are associated with a higher risk of sICH. However, the overall rate of sICH in the presence of CMB is very low, indicating that the presence of CMBs by itself should not dictate the decision to treat with thrombolytics.
急性缺血性卒中后静脉注射组织型纤溶酶原激活剂（IV tPA）存在发生症状性颅内出血（sICH）的风险。脑微出血（CMB）可能提示出血风险增加，可通过磁共振成像（MRI）观察到。在本研究中，我们研究了CMB与sICH之间的关联，重点关注其存在、负担和位置的预测价值。
回顾性分析了5年间两个学术性卒中中心所有接受IV tPA治疗的急性缺血性卒中患者的记录。评估了人口统计学、医学和影像学变量。在入院时获得的梯度回波MRI序列上记录CMB的存在、数量和位置（叶性与非叶性）。使用单变量和多变量统计模型来确定CMB与出血性（症状性和无症状性）转化之间的关系。
292例患者（平均年龄62.8岁（标准差15.3），49%为非裔美国人，52%为女性）中，21%（n = 62）至少有一处CMB，1%（n = 3）有超过10处CMB，1%（n = 3）被诊断为可能的脑淀粉样血管病。治疗后，16%（n = 46）发生出血性转化，其中6例（2%）为sICH。CMB的存在（p = 0.135）或位置（p = 0.325）与sICH之间无关联；然而，CMB负担高（>10处CMB）的患者更有可能发生sICH（OR 37.8；95%CI：2.7 - 539.3；p = 0.007）。
我们的研究结果支持先前的研究结果，即接受IV tPA治疗的急性卒中患者中，CMB负担高（>10处）与sICH风险较高相关。然而，存在CMB时sICH的总体发生率非常低，这表明CMB的存在本身不应决定是否进行溶栓治疗的决策。
