Cerebral Microbleeds and Risk of Intracerebral Hemorrhage Post Intravenous Thrombolysis

Ramin Zand, Georgios Tsivgoulis, Mantinderpreet Singh, Michael McCormack, Nitin Goyal, Muhammad Fawad Ishfaq, Reza Bavarsad Shahripour, Katherine Nearing, Lucas Elijovich, Anne Alexandrov, David S. Liebeskind, Andrei Alexandrov

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background Stroke patients who have cerebral micro bleeds (CMBs) could be potentially at a greater risk for symptomatic intracerebral hemorrhage (sICH) than those patients without CMBs. The aim of our study was to investigate whether the presence and burden of CMBs are associated with post IVT sICH. Methods In this multicenter study, consecutive patients treated with intravenous tissue plasminogen activator were prospectively identified and analyzed. Patients without magnetic resonance imaging (MRI) within 24 hours of treatment were excluded. CMBs were defined as round or oval, hypointense lesions with associated blooming on T2*-weighted MRI up to 10 mm in diameter. Outcome measures included the occurrence of sICH or death. Results Of 672 patients with IVT (mean age 62 ± 14 years, 52% men, median admission NIHSS: 7 points), 103 patients had CMBs on T2*-MRI. Ten patients had more than 10, whereas the remaining 93 patients had 1-10 CMBs on T2*-MRI. The rates of sICH did not differ between patients with and patients without 1-10 CMBs (5.8% versus 3.5%; P = .27). However, sICH occurred more frequently (P = .0009) in patients with > 10 CMBs (30%, 95% confidence interval [CI] by the adjusted Wald method: 10%-61%). After adjusting for potential confounders, the presence of >10 CMBs on T2*-MRI was independently (P = .0004) associated with a higher likelihood for sICH (odds ratio [OR]:13.4, 95%CI:3.2-55.9). Conclusions Our findings indicate an increased risk of sICH after IVT when more than 10 CMBs are present.

Original languageEnglish (US)
Pages (from-to)538-544
Number of pages7
JournalJournal of Stroke and Cerebrovascular Diseases
Volume26
Issue number3
DOIs
StatePublished - Mar 1 2017

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Cerebral Hemorrhage
Magnetic Resonance Imaging
Confidence Intervals
Tissue Plasminogen Activator
Multicenter Studies
Stroke
Odds Ratio
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

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Cerebral Microbleeds and Risk of Intracerebral Hemorrhage Post Intravenous Thrombolysis. / Zand, Ramin; Tsivgoulis, Georgios; Singh, Mantinderpreet; McCormack, Michael; Goyal, Nitin; Ishfaq, Muhammad Fawad; Shahripour, Reza Bavarsad; Nearing, Katherine; Elijovich, Lucas; Alexandrov, Anne; Liebeskind, David S.; Alexandrov, Andrei.

In: Journal of Stroke and Cerebrovascular Diseases, Vol. 26, No. 3, 01.03.2017, p. 538-544.

Research output: Contribution to journalArticle

Zand, Ramin ; Tsivgoulis, Georgios ; Singh, Mantinderpreet ; McCormack, Michael ; Goyal, Nitin ; Ishfaq, Muhammad Fawad ; Shahripour, Reza Bavarsad ; Nearing, Katherine ; Elijovich, Lucas ; Alexandrov, Anne ; Liebeskind, David S. ; Alexandrov, Andrei. / Cerebral Microbleeds and Risk of Intracerebral Hemorrhage Post Intravenous Thrombolysis. In: Journal of Stroke and Cerebrovascular Diseases. 2017 ; Vol. 26, No. 3. pp. 538-544.
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abstract = "Background Stroke patients who have cerebral micro bleeds (CMBs) could be potentially at a greater risk for symptomatic intracerebral hemorrhage (sICH) than those patients without CMBs. The aim of our study was to investigate whether the presence and burden of CMBs are associated with post IVT sICH. Methods In this multicenter study, consecutive patients treated with intravenous tissue plasminogen activator were prospectively identified and analyzed. Patients without magnetic resonance imaging (MRI) within 24 hours of treatment were excluded. CMBs were defined as round or oval, hypointense lesions with associated blooming on T2*-weighted MRI up to 10 mm in diameter. Outcome measures included the occurrence of sICH or death. Results Of 672 patients with IVT (mean age 62 ± 14 years, 52{\%} men, median admission NIHSS: 7 points), 103 patients had CMBs on T2*-MRI. Ten patients had more than 10, whereas the remaining 93 patients had 1-10 CMBs on T2*-MRI. The rates of sICH did not differ between patients with and patients without 1-10 CMBs (5.8{\%} versus 3.5{\%}; P = .27). However, sICH occurred more frequently (P = .0009) in patients with > 10 CMBs (30{\%}, 95{\%} confidence interval [CI] by the adjusted Wald method: 10{\%}-61{\%}). After adjusting for potential confounders, the presence of >10 CMBs on T2*-MRI was independently (P = .0004) associated with a higher likelihood for sICH (odds ratio [OR]:13.4, 95{\%}CI:3.2-55.9). Conclusions Our findings indicate an increased risk of sICH after IVT when more than 10 CMBs are present.",
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T1 - Cerebral Microbleeds and Risk of Intracerebral Hemorrhage Post Intravenous Thrombolysis

AU - Zand, Ramin

AU - Tsivgoulis, Georgios

AU - Singh, Mantinderpreet

AU - McCormack, Michael

AU - Goyal, Nitin

AU - Ishfaq, Muhammad Fawad

AU - Shahripour, Reza Bavarsad

AU - Nearing, Katherine

AU - Elijovich, Lucas

AU - Alexandrov, Anne

AU - Liebeskind, David S.

AU - Alexandrov, Andrei

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Background Stroke patients who have cerebral micro bleeds (CMBs) could be potentially at a greater risk for symptomatic intracerebral hemorrhage (sICH) than those patients without CMBs. The aim of our study was to investigate whether the presence and burden of CMBs are associated with post IVT sICH. Methods In this multicenter study, consecutive patients treated with intravenous tissue plasminogen activator were prospectively identified and analyzed. Patients without magnetic resonance imaging (MRI) within 24 hours of treatment were excluded. CMBs were defined as round or oval, hypointense lesions with associated blooming on T2*-weighted MRI up to 10 mm in diameter. Outcome measures included the occurrence of sICH or death. Results Of 672 patients with IVT (mean age 62 ± 14 years, 52% men, median admission NIHSS: 7 points), 103 patients had CMBs on T2*-MRI. Ten patients had more than 10, whereas the remaining 93 patients had 1-10 CMBs on T2*-MRI. The rates of sICH did not differ between patients with and patients without 1-10 CMBs (5.8% versus 3.5%; P = .27). However, sICH occurred more frequently (P = .0009) in patients with > 10 CMBs (30%, 95% confidence interval [CI] by the adjusted Wald method: 10%-61%). After adjusting for potential confounders, the presence of >10 CMBs on T2*-MRI was independently (P = .0004) associated with a higher likelihood for sICH (odds ratio [OR]:13.4, 95%CI:3.2-55.9). Conclusions Our findings indicate an increased risk of sICH after IVT when more than 10 CMBs are present.

AB - Background Stroke patients who have cerebral micro bleeds (CMBs) could be potentially at a greater risk for symptomatic intracerebral hemorrhage (sICH) than those patients without CMBs. The aim of our study was to investigate whether the presence and burden of CMBs are associated with post IVT sICH. Methods In this multicenter study, consecutive patients treated with intravenous tissue plasminogen activator were prospectively identified and analyzed. Patients without magnetic resonance imaging (MRI) within 24 hours of treatment were excluded. CMBs were defined as round or oval, hypointense lesions with associated blooming on T2*-weighted MRI up to 10 mm in diameter. Outcome measures included the occurrence of sICH or death. Results Of 672 patients with IVT (mean age 62 ± 14 years, 52% men, median admission NIHSS: 7 points), 103 patients had CMBs on T2*-MRI. Ten patients had more than 10, whereas the remaining 93 patients had 1-10 CMBs on T2*-MRI. The rates of sICH did not differ between patients with and patients without 1-10 CMBs (5.8% versus 3.5%; P = .27). However, sICH occurred more frequently (P = .0009) in patients with > 10 CMBs (30%, 95% confidence interval [CI] by the adjusted Wald method: 10%-61%). After adjusting for potential confounders, the presence of >10 CMBs on T2*-MRI was independently (P = .0004) associated with a higher likelihood for sICH (odds ratio [OR]:13.4, 95%CI:3.2-55.9). Conclusions Our findings indicate an increased risk of sICH after IVT when more than 10 CMBs are present.

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