From the Departments of Neuroradiology (I.D., F.C., C.D., R.A., P.-H.L., C.R., G.G., A.B., V.C.) and Neurology (N.G., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, France; and Department of Clinical and Experimental Medicine (R.M.), Section of Statistics, University of Pisa, Italy.
Neurology. 2021 Mar 30;96(13):e1724-e1731. doi: 10.1212/WNL.0000000000011566. Epub 2021 Jan 25.
To determine whether pretreatment cerebral microbleeds (CMBs) presence and burden are correlated with an increased risk of intracranial hemorrhage (ICH) or poor functional outcome following endovascular thrombectomy (EVT) for acute ischemic stroke (AIS).
Consecutive patients treated by EVT for anterior circulation AIS were retrospectively analyzed. Experienced neuroradiologists blinded to functional outcomes rated CMBs on T2*-MRI using a validated scale. We investigated associations of CMB presence and burden with ICH and poor clinical outcome at 3 months (modified Rankin Scale score >2).
Among 513 patients, 281 (54.8%) had a poor outcome and 89 (17.3%) had ≥1 CMBs. A total of 190 (37%) patients experienced ICH; 66 (12.9%) were symptomatic. CMB burden was associated with poor outcome in a univariable analysis (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.03-1.36 per 1-CMB increase; = 0.02), but significance was lost after adjustment for sex, age, stroke severity, hypertension, diabetes mellitus, atrial fibrillation, prior antithrombotic medication, IV thrombolysis, and reperfusion status (OR, 1.05; 95% CI, 0.92-1.20 per 1-CMB increase; = 0.50). Results remained nonsignificant when taking into account CMB location or presumed underlying pathogenesis. CMB presence, burden, location, or presumed pathogenesis were not independently correlated with ICH.
Poor functional outcome or ICH were not correlated with CMB presence or burden on pre-EVT MRI after adjustment for confounding factors. Excluding such patients from reperfusion therapies is unwarranted.
This study provides Class II evidence that in patients with AIS undergoing EVT, after adjustment for confounding factors, the presence of CMBs is not significantly associated with clinical outcome or the risk of ICH.
确定急性缺血性脑卒中（AIS）患者血管内血栓切除术（EVT）前存在和负荷的脑微出血（CMBs）是否与颅内出血（ICH）风险增加或功能预后不良相关。
回顾性分析了接受 EVT 治疗的前循环 AIS 连续患者。经验丰富的神经放射科医生使用经过验证的量表对 T2*-MRI 上的 CMBs 进行盲法功能评估。我们研究了 CMB 存在和负荷与 ICH 和 3 个月时不良临床结局（改良 Rankin 量表评分>2）的相关性。
在 513 例患者中，281 例（54.8%）预后不良，89 例（17.3%）有≥1 个 CMBs。共有 190 例（37%）患者发生 ICH，66 例（12.9%）为症状性 ICH。单变量分析中，CMB 负荷与不良预后相关（优势比[OR]，每增加 1 个 CMB 增加 1.18；95%置信区间[CI]，1.03-1.36； = 0.02），但调整性别、年龄、卒中严重程度、高血压、糖尿病、心房颤动、既往抗血栓药物、静脉溶栓和再灌注状态后，差异无统计学意义（OR，每增加 1 个 CMB 增加 1.05；95%CI，0.92-1.20； = 0.50）。考虑到 CMB 位置或假定的潜在发病机制后，结果仍无统计学意义。CMB 的存在、负荷、位置或假定的发病机制与 ICH 无独立相关性。
在调整混杂因素后，EVT 前 MRI 上存在或负荷的 CMBs 与功能不良或 ICH 无相关性。排除此类患者接受再灌注治疗是不合理的。
本研究提供了 II 级证据，表明在接受 EVT 的 AIS 患者中，在调整混杂因素后，CMBs 的存在与临床结局或 ICH 风险无显著相关性。
