Department of Cardiovascular Medicine, Suita, Osaka, Japan.
Stroke and Cerebrovascular Disease, Suita, Osaka, Japan.
Heart Vessels. 2024 Sep;39(9):763-770. doi: 10.1007/s00380-024-02404-7. Epub 2024 Apr 12.
Cerebral microbleeds (CMBs) on brain magnetic resonance imaging (MRI) are predictive of intracerebral hemorrhage (ICH). However, the risk of ICH in patients with CMBs who undergo percutaneous coronary intervention (PCI) while receiving dual antiplatelet therapy (DAPT) is unclear.
We conducted a study on 329 consecutive patients with coronary artery disease who underwent PCI and were evaluated using a 3T MRI scanner. Based on T2*-weighted imaging, patients were classified into three groups: no CMBs, < 5 CMBs, or ≥ 5 CMBs. We determined the occurrence of ICH during follow-up.
At least 1 CMB was found in 109 (33%) patients. The mean number of CMBs per patient was 2.9 ± 3.6. Among the 109 patients with CMBs, 16 (15%) had ≥ 5 CMBs. Coronary stent implantation was performed in 321 patients (98%). DAPT was prescribed for 325 patients (99%). During a mean follow-up period of 2.3 years (interquartile range, 1.9-2.5 years), ICH occurred in one patient (1.1%) with four CMBs. There were no significant differences in the incidence of ICH (0% vs. 1.1% vs. 0%; p = 0.28). However, the rate of DAPT at 6 months of follow-up was significantly lower in patients with ≥ 5 CMBs than in patients with no CMBs or < 5 CMBs (89% vs. 91% vs. 66%, p = 0.026). Furthermore, there were no significant differences in systemic blood pressure during follow-up (123 ± 16 vs. 125 ± 16 vs. 118 ± 11 mmHg; p = 0.40).
Although a substantial number of patients who underwent PCI had cerebral microbleeds, at approximately two years of follow-up, intracerebral hemorrhage was very rare in our study population.
脑磁共振成像（MRI）上的脑微出血（CMB）可预测脑出血（ICH）。然而，在接受双联抗血小板治疗（DAPT）的同时接受经皮冠状动脉介入治疗（PCI）的 CMB 患者中发生 ICH 的风险尚不清楚。
我们对 329 例连续接受 PCI 治疗的冠心病患者进行了研究，并使用 3T MRI 扫描仪进行了评估。根据 T2*-加权成像，患者分为三组：无 CMB、<5 个 CMB 或≥5 个 CMB。我们确定了随访期间 ICH 的发生情况。
109 例（33%）患者至少发现 1 个 CMB。每位患者的 CMB 平均数为 2.9±3.6。在 109 例有 CMB 的患者中，16 例（15%）有≥5 个 CMB。321 例患者（98%）植入了冠状动脉支架。325 例患者（99%）开具了 DAPT。在平均 2.3 年（四分位距 1.9-2.5 年）的随访期间，1 例（1.1%）有 4 个 CMB 的患者发生 ICH。ICH 的发生率无显著差异（0% vs. 1.1% vs. 0%；p=0.28）。然而，在 6 个月的随访中，≥5 个 CMB 的患者 DAPT 的使用率明显低于无 CMB 或<5 个 CMB 的患者（89% vs. 91% vs. 66%；p=0.026）。此外，随访期间的系统血压无显著差异（123±16 vs. 125±16 vs. 118±11 mmHg；p=0.40）。
尽管接受 PCI 的患者中有相当数量的人存在脑微出血，但在我们的研究人群中，大约两年的随访期间，ICH 非常罕见。
