Tipirneni Shraddha, Stanwell Peter, Weissert Robert, Bhaskar Sonu M M
Global Health Neurology Lab, Sydney, NSW 2150, Australia.
UNSW Medicine and Health, South Western Sydney Clinical Campuses, University of New South Wales (UNSW), Sydney, NSW 2170, Australia.
Biomedicines. 2023 Oct 23;11(10):2865. doi: 10.3390/biomedicines11102865.
Cerebral microbleeds (CMBs), a notable neuroimaging finding often associated with cerebral microangiopathy, demonstrate a heightened prevalence in patients diagnosed with acute ischemic stroke (AIS), which is in turn linked to less favourable clinical prognoses. Nevertheless, the exact prevalence of CMBs and their influence on post-reperfusion therapy outcomes remain inadequately elucidated.
Through systematic searches of PubMed, Embase and Cochrane databases, studies were identified adhering to specific inclusion criteria: (a) AIS patients, (b) age ≥ 18 years, (c) CMBs at baseline, (d) availability of comparative data between CMB-positive and CMB-negative groups, along with relevant post-reperfusion therapy outcomes. The data extracted were analysed using forest plots of odds ratios, and random-effects modelling was applied to investigate the association between CMBs and symptomatic intracerebral haemorrhage (sICH), haemorrhagic transformation (HT), 90-day functional outcomes, and 90-day mortality post-reperfusion therapy.
In a total cohort of 9776 AIS patients who underwent reperfusion therapy, 1709 had CMBs, with a pooled prevalence of 19% (ES 0.19; 95% CI: 0.16, 0.23, < 0.001). CMBs significantly increased the odds of sICH (OR 2.57; 95% CI: 1.72; 3.83; < 0.0001), HT (OR 1.53; 95% CI: 1.25; 1.88; < 0.0001), as well as poor functional outcomes at 90 days (OR 1.59; 95% CI: 1.34; 1.89; < 0.0001) and 90-day mortality (OR 1.65; 95% CI: 1.27; 2.16; < 0.0001), relative to those without CMBs, in AIS patients undergoing reperfusion therapy (encompassing intravenous thrombolysis [IVT], endovascular thrombectomy [EVT], either IVT or EVT, and bridging therapy). Variations in the level of association can be observed among different subgroups of reperfusion therapy.
This meta-analysis underscores a significant association between CMBs and adverse postprocedural safety outcomes encompassing sICH, HT, poor functional outcome, and increased mortality in AIS patients undergoing reperfusion therapy. The notable prevalence of CMBs in both the overall AIS population and those undergoing reperfusion therapy emphasizes their importance in post-stroke prognostication.
脑微出血（CMBs）是一种常与脑微血管病变相关的显著神经影像学表现，在诊断为急性缺血性卒中（AIS）的患者中患病率较高，而这又与较差的临床预后相关。然而，CMBs的确切患病率及其对再灌注治疗结果的影响仍未得到充分阐明。
通过系统检索PubMed、Embase和Cochrane数据库，确定符合特定纳入标准的研究：（a）AIS患者；（b）年龄≥18岁；（c）基线时有CMBs；（d）CMB阳性组和CMB阴性组之间有比较数据以及相关的再灌注治疗结果。提取的数据使用比值比的森林图进行分析，并应用随机效应模型来研究CMBs与症状性脑出血（sICH）、出血性转化（HT）、90天功能结局以及再灌注治疗后90天死亡率之间的关联。
在总共9776例接受再灌注治疗的AIS患者队列中，1709例有CMBs，合并患病率为19%（效应量0.19；95%置信区间：0.16，0.23，P<0.001）。在接受再灌注治疗（包括静脉溶栓[IVT]、血管内血栓切除术[EVT]、IVT或EVT以及桥接治疗）的AIS患者中，相对于没有CMBs的患者，CMBs显著增加了sICH（比值比2.57；95%置信区间：1.72；3.83；P<0.0001）、HT（比值比1.53；95%置信区间：1.25；1.88；P<0.0001）、90天时功能结局不良（比值比1.59；95%置信区间：1.34；1.89；P<0.0001）和90天死亡率（比值比1.65；95%置信区间：1.27；2.16；P<0.0001）的发生几率。在不同的再灌注治疗亚组中可以观察到关联程度的差异。
这项荟萃分析强调了CMBs与接受再灌注治疗的AIS患者术后不良安全结局之间的显著关联，这些不良结局包括sICH、HT、功能结局不良和死亡率增加。CMBs在总体AIS人群和接受再灌注治疗的患者中显著的患病率强调了它们在卒中后预后评估中的重要性。
