nach oben

Journal of Neurology

Erschienen in:

24.11.2016 | Review

The impact of cerebral microbleeds on intracerebral hemorrhage and poor functional outcome of acute ischemic stroke patients treated with intravenous thrombolysis: a systematic review and meta-analysis

verfasst von: Shuang Wang, Yan Lv, Xin Zheng, Jing Qiu, Hui-Sheng Chen

Erschienen in: Journal of Neurology | Ausgabe 7/2017

Einloggen, um Zugang zu erhalten

Abstract

It is still controversial whether pre-existing cerebral microbleeds (CMBs) increase the risks of intracranial hemorrhage (ICH) and poor functional outcome (PFO) in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT). Therefore, we performed a systematic review and meta-analysis to determine the impact of CMBs on ICH and PFO of AIS patients with IVT. We searched PubMed, EMBASE and Web of Science from inception to August 3, 2016, with language restriction in English. We included studies that reported the relationship between CMBs and ICH or PFO after thrombolysis. Two retrospective and nine prospective studies met inclusion criteria (total 2702 patients). The overall prevalence of CMBs on pre-IVT MRI scans was 24.0%. Pre-existing CMBs on MRI scans were not significantly associated with a higher risk of early sICH (OR 1.74; 95% CI 0.91–3.33; I ² = 44.5%). Subgroup analyses did not substantially influence these associations. The presence of CMBs was associated with the increased risk of 3-month PFO (OR 1.58; 95% CI 1.08–2.31; I ² = 54.2%), PH (OR 2.14; 95% CI 1.34–3.42; I ² = 11.0%) and any ICH (OR 1.42; 95% CI 1.04–1.95; I ² = 0.0%), respectively. This meta-analysis showed that CMBs presence was not significantly associated with the increased risk of early sICH after IVT. However, the results also demonstrated that CMBs presence increased the risks of 3-month PFO, PH and any ICH after IVT. Due to a small number of included studies and methodological limitations, the results of this meta-analysis should be interpreted cautiously. CMBs presence should not be a contraindication to IVT for AIS patients based on the existing evidence.

Endres M, Heuschmann PU, Laufs U, Hakim AM (2011) Primary prevention of stroke: blood pressure, lipids, and heart failure. Eur Heart J 32(5):545–552CrossRefPubMed

Emberson J, Lees K, Lyden P, Blackwell L, Albers G, Bluhmki E, Brott T, Cohen G, Davis S, Donnan G, Stroke Thrombolysis Trialists’ Collaborative Group (2014) Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet 384(9958):1929–1935CrossRefPubMedPubMedCentral

Atlantis T (2004) Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet 363(9411):768–774CrossRef

Yaghi S, Boehme AK, Dibu J, Guerrero CRL, Ali S, Martin-Schild S, Sands KA, Noorian AR, Blum CA, Chaudhary S (2015) Treatment and outcome of thrombolysis-related hemorrhage: a multicenter retrospective study. JAMA Neurol 72(12):1451–1457CrossRefPubMedPubMedCentral

Greenberg SM, Vernooij MW, Cordonnier C, Viswanathan A, Salman RA-S, Warach S, Launer LJ, Van Buchem MA, Breteler MM, Group MS (2009) Cerebral microbleeds: a guide to detection and interpretation. Lancet Neurol 8(2):165–174CrossRefPubMedPubMedCentral

Cordonnier C, Salman RA-S, Wardlaw J (2007) Spontaneous brain microbleeds: systematic review, subgroup analyses and standards for study design and reporting. Brain 130(8):1988–2003CrossRefPubMed

Poels MMF, Vernooij MW, Ikram MA, Hofman A, Krestin GP, Der Lugt AV, Breteler MMB (2010) Prevalence and risk factors of cerebral microbleeds an update of the Rotterdam scan study. Stroke:41

Gregoire SM, Brown MM, Kallis C, Jager R, Yousry TA, Werring DJ (2010) MRI detection of new microbleeds in patients with ischemic stroke. Five-year cohort follow-up study. Stroke 41(1):184–186CrossRefPubMed

Orken DN, Uysal E, Timer E, Kuloglu-Pazarcı N, Mumcu S, Forta H (2013) New cerebral microbleeds in ischemic stroke patients on warfarin treatment: two-year follow-up. Clin Neurol Neurosurg 115(9):1682–1685CrossRefPubMed

10.

Huang Y, Cheng Y, Wu J, Li Y, Xu E, Hong Z, Li Z, Zhang W, Ding M, Gao X (2008) Cilostazol as an alternative to aspirin after ischaemic stroke: a randomised, double-blind, pilot study. Lancet Neurol 7(6):494–499CrossRefPubMed

11.

Yan S, Jin X, Zhang X, Zhang S, Liebeskind DS, Lou M (2015) Extensive cerebral microbleeds predict parenchymal haemorrhage and poor outcome after intravenous thrombolysis. J Neurol Neurosurg Psychiatry 86(11):1267–1272. doi:10.1136/jnnp-2014-309857 CrossRefPubMed

12.

Turc G, Sallem A, Moulin S, Tisserand M, Machet A, Edjlali M, Baron JC, Leclerc X, Leys D, Mas JL, Cordonnier C, Oppenheim C (2015) Microbleed status and 3-month outcome after intravenous thrombolysis in 717 patients with acute ischemic stroke. Stroke 46(9):2458–2463. doi:10.1161/strokeaha.115.009290 CrossRefPubMed

13.

Dannenberg S, Scheitz JF, Rozanski M, Erdur H, Brunecker P, Werring DJ, Fiebach JB, Nolte CH (2014) Number of cerebral microbleeds and risk of intracerebral hemorrhage after intravenous thrombolysis. Stroke 45(10):2900–2905. doi:10.1161/strokeaha.114.006448 CrossRefPubMed

14.

Cai J, Fu J, Yan S, Hu H, Lin C (2015) Clinical outcome in acute ischemic stroke patients with microbleeds after thrombolytic therapy: a meta-Analysis. Medicine 94(52):e2379. doi:10.1097/md.0000000000002379 CrossRefPubMedPubMedCentral

15.

Charidimou A, Shoamanesh A, Wilson D, Gang Q, Fox Z, Jager HR, Benavente OR, Werring DJ (2015) Cerebral microbleeds and postthrombolysis intracerebral hemorrhage risk updated meta-analysis. Neurology 85(11):927–934. doi:10.1212/wnl.0000000000001923 CrossRefPubMedPubMedCentral

16.

Tsivgoulis G, Zand R, Katsanos AH, Turc G, Nolte CH, Jung S, Cordonnier C, Fiebach JB, Scheitz JF, Klinger-Gratz PP, Oppenheim C, Goyal N, Safouris A, Mattle HP, Alexandrov AW, Schellinger PD, Alexandrov AV (2016) Risk of symptomatic intracerebral hemorrhage after intravenous thrombolysis in patients with acute ischemic stroke and high cerebral microbleed burden: a meta-analysis. JAMA Neurol 73(6):675–683. doi:10.1001/jamaneurol.2016.0292 CrossRefPubMed

17.

Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151(4):264–269. doi:10.7326/0003-4819-151-4-200908180-00135 CrossRefPubMed

18.

Wells G, Shea B, O’connell D, Peterson J, Welch V, Losos M, Tugwell P (2000) The Newcastle–Ottawa Scale (NOS) for assessing the quality of non-randomised studies in meta-analyses

19.

Higgins JPT, Thompson S, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560CrossRefPubMedPubMedCentral

20.

Egger M, Smith GD, Schneider M, Minder CE (1997) Bias in meta›analysis detected by a simple, graphical test. BMJ 315(7109):629CrossRefPubMedPubMedCentral

21.

Annan M, Cottier JP, Gaudron M, Dejobert M, De Toffol B, Debiais S (2015) Microbleeds: not more hemorrhagic transformation after thrombolysis. Eur J Neurol 22:126

22.

Derex L, Nighoghossian N, Hermier M, Adeleine P, Philippeau F, Honnorat J, Yilmaz H, Dardel P, Froment JC, Trouillas P (2004) Thrombolysis for ischemic stroke in patients with old microbleeds on pretreatment MRI. Cerebrovasc Dis (Basel, Switzerland) 17(2–3):238–241. doi:10.1159/000076123

23.

Fiehler J, Albers GW, Boulanger JM, Derex L, Gass A, Hjort N, Kim JS, Liebeskind DS, Neumann-Haefelin T, Pedraza S, Rother J, Rothwell P, Rovira A, Schellinger PD, Trenkler J, Grp MS (2007) Bleeding risk analysis in stroke imaging before thrombolysis (BRASIL)—pooled analysis of t2*-weighted magnetic resonance imaging data from 570 patients. Stroke 38(10):2738–2744. doi:10.1161/strokeaha.106.480848 CrossRefPubMed

24.

Gratz PP, El-Koussy M, Hsieh K, von Arx S, Mono ML, Heldner MR, Fischer U, Mattle HP, Zubler C, Schroth G, Gralla J, Arnold M, Jung S (2014) Preexisting cerebral microbleeds on susceptibility-weighted magnetic resonance imaging and post-thrombolysis bleeding risk in 392 patients. Stroke 45(6):1684–1688. doi:10.1161/strokeaha.114.004796 CrossRefPubMed

25.

Kakuda W, Thijs VN, Lansberg MG, Bammer R, Wechsler L, Kemp S, Moseley ME, Marks MP, Albers GW, Investigators D (2005) Clinical importance of microbleeds in patients receiving IV thrombolysis. Neurology 65(8):1175–1178. doi:10.1212/01.wnl.0000180519.27680.0f CrossRefPubMed

26.

Kimura K, Aoki J, Shibazaki K, Saji N, Uemura J, Sakamoto Y (2013) New appearance of extraischemic microbleeds on T2*-weighted magnetic resonance imaging 24 hours after tissue-type plasminogen activator administration. Stroke 44(10):2776–2781. doi:10.1161/strokeaha.113.001778 CrossRefPubMed

27.

Moriya Y, Takahashi W, Kijima C, Yutani S, Iijima E, Mizuma A, Honma K, Uesugi T, Ohnuki Y, Nagata E, Yanagimachi N, Takizawa S (2013) Predictors for hemorrhagic transformation with intravenous tissue plasminogen activator in acute ischemic stroke. Tokai J Exp Clin Med 38(1):24–27PubMed

28.

Takahashi Y, Morihara R, Narai H, Omori N, Manabe Y (2014) Acute neuroimaging analysis of the risk of hemorrhagic complications in acute ischemic stroke patients with microbleeds after intravenous recombinant tissue plasminogen activator therapy. Int J Stroke 9:57–58CrossRef

29.

Shoamanesh A, Kwok CS, Lim PA, Benavente OR (2013) Postthrombolysis intracranial hemorrhage risk of cerebral microbleeds in acute stroke patients: a systematic review and meta-analysis. Int J Stroke 8(5):348–356. doi:10.1111/j.1747-4949.2012.00869.x CrossRefPubMed

30.

Wu Y, Chen T (2016) An Up-To-Date Review On Cerebral Microbleeds. J Stroke Cerebrovasc Dis 25(6):1301–1306. doi:10.1016/j.jstrokecerebrovasdis.2016.03.005 CrossRefPubMed

31.

Smith EE, Greenberg SM (2001) Clinical diagnosis of cerebral amyloid angiopathy: validation of the Boston criteria. Neurology 56(4):537–539CrossRef

32.

Yakushiji Y (2015) Cerebral microbleeds: detection, associations and clinical implications. Front Neurol Neurosci 37:78–92. doi:10.1159/000437115 CrossRefPubMed

33.

Viswanathan M, Salman RA-S, Steven Warach M, Lenore J (2009) Cerebral microbleeds: a field guide to their detection and interpretation. Lancet Neurol 8(2):165–174CrossRefPubMedPubMedCentral

34.

Fazekas F, Kleinert R, Roob G, Kleinert G, Kapeller P, Schmidt R, Hartung HP (1999) Histopathologic analysis of foci of signal loss on gradient-echo T2*-weighted MR images in patients with spontaneous intracerebral hemorrhage: evidence of microangiopathy-related microbleeds. Am J Neuroradiol 20(4):637–642PubMed

35.

Dzialowski I, Pexman JW, Barber PA, Demchuk AM, Buchan AM, Hill MD, Investigators C (2007) Asymptomatic hemorrhage after thrombolysis may not be benign prognosis by hemorrhage type in the Canadian Alteplase for Stroke Effectiveness Study Registry. Stroke 38(1):75–79CrossRefPubMed

36.

Thorlund K, Imberger G, Walsh M, Chu R, Gluud C, Wetterslev J, Guyatt G, Devereaux PJ, Thabane L (2011) The number of patients and events required to limit the risk of overestimation of intervention effects in meta-analysis—a simulation study. PLoS One 6(10):e25491CrossRefPubMedPubMedCentral

37.

Wahlgren N, Ahmed N, Eriksson N, Aichner F, Bluhmki E, Dávalos A, Erilä T, Ford GA, Grond M, Hacke W (2008) Multivariable analysis of outcome predictors and adjustment of main outcome results to baseline data profile in randomized controlled trials safe implementation of thrombolysis in stroke-monitoring study (SITS-MOST). Stroke 39(12):3316–3322CrossRefPubMed

38.

Arsava E, Rahman R, Rosand J, Lu J, Smith E, Rost N, Singhal A, Lev M, Furie K, Koroshetz W (2009) Severity of leukoaraiosis correlates with clinical outcome after ischemic stroke. Neurology 72(16):1403–1410CrossRefPubMedPubMedCentral

39.

Cheng A-L, Batool S, McCreary CR, Lauzon M, Frayne R, Goyal M, Smith EE (2013) Susceptibility-weighted imaging is more reliable than T2*-weighted gradient-recalled echo MRI for detecting microbleeds. Stroke 44(10):2782–2786CrossRefPubMed

Titel: The impact of cerebral microbleeds on intracerebral hemorrhage and poor functional outcome of acute ischemic stroke patients treated with intravenous thrombolysis: a systematic review and meta-analysis
verfasst von: Shuang Wang
Yan Lv
Xin Zheng
Jing Qiu
Hui-Sheng Chen
Publikationsdatum: 24.11.2016
Verlag: Springer Berlin Heidelberg
Erschienen in: Journal of Neurology / Ausgabe 7/2017
Print ISSN: 0340-5354
Elektronische ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-016-8339-1

Leitlinien kompakt für die Neurologie

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Neurologie

Nicht Creutzfeldt Jakob, sondern Abführtee-Vergiftung

29.05.2024 Hyponatriämie Nachrichten

Eine ältere Frau trinkt regelmäßig Sennesblättertee gegen ihre Verstopfung. Der scheint plötzlich gut zu wirken. Auf Durchfall und Erbrechen folgt allerdings eine Hyponatriämie. Nach deren Korrektur kommt es plötzlich zu progredienten Kognitions- und Verhaltensstörungen.

Schutz der Synapsen bei Alzheimer

29.05.2024 Morbus Alzheimer Nachrichten

Mit einem Neurotrophin-Rezeptor-Modulator lässt sich möglicherweise eine bestehende Alzheimerdemenz etwas abschwächen: Erste Phase-2-Daten deuten auf einen verbesserten Synapsenschutz.

Sozialer Aufstieg verringert Demenzgefahr

24.05.2024 Demenz Nachrichten

Ein hohes soziales Niveau ist mit die beste Versicherung gegen eine Demenz. Noch geringer ist das Demenzrisiko für Menschen, die sozial aufsteigen: Sie gewinnen fast zwei demenzfreie Lebensjahre. Umgekehrt steigt die Demenzgefahr beim sozialen Abstieg.

Hirnblutung unter DOAK und VKA ähnlich bedrohlich

17.05.2024 Direkte orale Antikoagulanzien Nachrichten

Kommt es zu einer nichttraumatischen Hirnblutung, spielt es keine große Rolle, ob die Betroffenen zuvor direkt wirksame orale Antikoagulanzien oder Marcumar bekommen haben: Die Prognose ist ähnlich schlecht.

Update Neurologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 7/2017

Abnormal vestibular-evoked myogenic potentials as an isolated finding of probable transient labyrinthine ischemia

External input for gait in people with Parkinson’s disease with and without freezing of gait: One size does not fit all

Multiple variants in families with amyotrophic lateral sclerosis and frontotemporal dementia related to C9orf72 repeat expansion: further observations on their oligogenic nature

Jacob Heine (1800–1879)

Higher blood–brain barrier permeability is associated with higher white matter hyperintensities burden