Capuana Maria Luisa, Lorenzano Svetlana, Caselli Maria Chiara, Paciaroni Maurizio, Toni Danilo
IRCCS Centro Neurolesi "Bonino Pulejo", Palermo, Italy.
Emergency Department Stroke Unit, Department of Human Neurosciences, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy.
Neurol Sci. 2021 May;42(5):1969-1976. doi: 10.1007/s10072-020-04720-y. Epub 2020 Sep 29.
Aim of this study was to evaluate the association between cerebral microbleeds (CMBs) and white matter disease (WMD) with intracerebral hemorrhage (ICH) after intravenous thrombolysis (IVT) with rt-PA. We also evaluated whether CMBs characteristics and WMD burden correlate with symptomatic ICH and outcome.
We included acute ischemic stroke (AIS) patients treated with IVT. The number and location of CMBs as well as severity of WMD were rated analyzing pre- or post-treatment MRI. Multivariable regression analysis was used to determine the impact of CMB and WMD on ICH subgroups and outcome measures.
434 patients were included. CMBs were detected in 23.3% of them. ICH occurred in 34.7% of patients with CMBs. Independent predictors of parenchymal hemorrhage were the presence of CMBs (OR 2.724, 95% CI 1.360-5.464, p = 0.005) as well as cortical-subcortical stroke (OR 3.629, 95% CI 1.841-7.151, p < 0.001) and atherothrombotic stroke subtype (OR 3.381, 95% CI 1.335-8.566, p = 0.010). Either the presence, or number, and location of CMBs, as well as WMD, was not independently associated with the development of SICH. No independent association between the presence, number, or location of CMBs or WMD and outcome measures was observed.
The results of our study suggest that the exclusion of eligible candidates to administration of IV rt-PA only on the basis of CMBs presence is not justified. The clinical decision should be weighed with a case-by-case approach. Additional data are needed to evaluate the benefit-risk profile of rt-PA in patients carrying numerous microbleeds.
本研究旨在评估脑微出血（CMBs）和白质病变（WMD）与重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓（IVT）后脑出血（ICH）之间的关联。我们还评估了CMBs特征和WMD负担是否与症状性ICH及预后相关。
我们纳入了接受IVT治疗的急性缺血性卒中（AIS）患者。通过分析治疗前或治疗后的磁共振成像（MRI）对CMBs的数量和位置以及WMD的严重程度进行评分。采用多变量回归分析来确定CMB和WMD对ICH亚组及预后指标的影响。
共纳入434例患者。其中23.3%检测到CMBs。34.7%的CMBs患者发生了ICH。脑实质出血的独立预测因素为CMBs的存在（比值比[OR]2.724，95%置信区间[CI]1.360 - 5.464，p = 0.005）、皮质 - 皮质下卒中（OR 3.629，95%CI 1.841 - 7.151，p < 0.001）和动脉粥样硬化血栓形成性卒中亚型（OR 3.381，95%CI 1.335 - 8.566，p = 0.010）。CMBs的存在、数量和位置以及WMD均与症状性脑出血（SICH）的发生无独立关联。未观察到CMBs或WMD的存在、数量或位置与预后指标之间存在独立关联。
我们的研究结果表明，仅基于CMBs的存在而排除IV rt-PA治疗的合格候选者是不合理的。临床决策应逐案权衡。需要更多数据来评估rt-PA在有大量微出血患者中的获益 - 风险情况。
