Cerebral microbleeds and risk of symptomatic hemorrhagic transformation following mechanical thrombectomy for large vessel ischemic stroke

• Published in: Journal of neurology Vol. 271; no. 5; pp. 2631 - 2638
• Main Authors: Agbonon, Rémi, Forestier, Géraud, Bricout, Nicolas, Benhassen, Wagih, Turc, Guillaume, Bretzner, Martin, Pasi, Marco, benzakoun, Joseph, Seners, Pierre, Derraz, Imad, Legrand, Laurence, Trystram, Denis, Rodriguez-Regent, Christine, Charidimou, Andreas, Rost, Natalia S., Bracard, Serge, Cordonnier, Charlotte, Eker, Omer F., Oppenheim, Catherine, Naggara, Olivier, Henon, Hilde, Boulouis, Grégoire
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.05.2024; Springer Nature B.V
• Series: Journal of Neurology
• Subjects: Aged; Aged, 80 and over; Cardiovascular system; Cerebral Hemorrhage - diagnostic imaging; Cerebral Hemorrhage - epidemiology; Cerebral Hemorrhage - etiology; Cerebral Small Vessel Diseases - complications; Cerebral Small Vessel Diseases - diagnostic imaging; Cerebral Small Vessel Diseases - epidemiology; Endovascular Procedures - adverse effects; Female; Hemorrhage; Humans; Ischemia; Ischemic Stroke - diagnostic imaging; Life Sciences; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; NCT; NCT01062698; Neurology; Neuroradiology; Neurosciences; Original Communication; Retrospective Studies; Stroke; Thrombectomy - adverse effects; Vascular diseases; Cerebral microbleeds; Stroke; Prognosis; MRI; Mechanical thrombectomy
• ISSN: 0340-5354; 1432-1459; 1432-1459
• DOI: 10.1007/s00415-024-12205-7

Background and purpose In patients with acute ischemic stroke (AIS) treated with endovascular therapy (EVT), the association of pre-existing cerebral small vessel disease (cSVD) with symptomatic intracerebral hemorrhage (sICH) remains controversial. We tested the hypothesis that the presence of cerebral microbleeds (CMBs) and their burden would be associated with sICH after EVT of AIS. Methods We conducted a retrospective study combining cohorts of patients that underwent EVT between January 1st 2015 and January 1st 2020. CMB presence, burden, and other cSVD markers were assessed on a pre-treatment MRI, evaluated independently by two observers. Primary outcome was the occurrence of sICH. Results 445 patients with pretreatment MRI were included, of which 70 (15.7%) demonstrated CMBs on baseline MRI. sICH occurred in 36 (7.6%) of all patients. Univariate analysis did not demonstrate an association between CMB and the occurrence of sICH (7.5% in CMB+ group vs 8.6% in CMB group, p  = 0.805). In multivariable models, CMBs’ presence was not significantly associated with increased odds for sICH (-aOR- 1.19; 95% CI [0.43–3.27], p  = 0.73). Only ASPECTs (aOR 0.71 per point increase; 95% CI [0.60–0.85], p  < 0.001) and collaterals status (aOR 0.22 for adequate versus poor collaterals; 95% CI [0.06–0.93], p 0.019) were independently associated with sICH. Conclusion CMB presence and burden is not associated with increased occurrence of sICH after EVT. This result incites not to exclude patients with CMBs from EVT. The risk of sICH after EVT in patients with more than10 CMBs will require further investigation. Registration Registration-URL: http://www.clinicaltrials.gov ; Unique identifier: NCT01062698.