title: Thrombolysis for ischemic stroke in patients with old microbleeds on pretreatment MRI.
abstract: BACKGROUND
  Old asymptomatic microbleeds (MBs) visualized on T2-weighted MRI are indicative of microangiopathy. They may be a marker of increased risk of intracerebral hemorrhage (ICH) following thrombolysis. However, data regarding this potential risk are limited.
  
  
  METHODS
  A retrospective analysis of pretreatment T2-weighted MRI was performed in consecutive stroke patients who received intravenous tissue plasminogen activator (tPA). We aimed to assess the impact of MBs on the risk of cerebral bleeding. The frequency and location of MBs were assessed and compared with the location of ICH after thrombolysis.
  
  
  RESULTS
  Forty-four patients were studied. MBs were present on pretreatment MRI in 8 cases (18.2%). At day 1, symptomatic ICH occurred in none of 8 patients with MBs versus 1 of 36 patients without (NS). At day 1, ICH occurred in 3 of 8 patients with MBs versus 10 of 36 patients without (NS). At day 7, symptomatic ICH occurred in 1 of 8 patients with MBs versus 2 of 36 patients without (NS). At day 7, ICH occurred in 5 of 8 patients with MBs versus 12 of 36 patients without (NS). No ICH occurred at the site of an MB. ICH occurred within the ischemic area in all patients who bled.
  
  
  CONCLUSIONS
  Our study suggests that stroke patients with a small number of MBs on pretreatment MRI could be treated safely with thrombolysis. Larger prospective studies are needed to address the predictive value of detection of MBs with regard to the risk of tPA-induced ICH.
authors.affiliation: Service d'Urgences Neurovasculaires, Hôpital Neurologique, Hospices Civils de Lyon, Lyon, France. laurent.derex@chu-lyon.fr
authors.forename: Laurent
authors.initials: L
authors.lastname: Derex
authors.forename: Norbert
authors.initials: N
authors.lastname: Nighoghossian
authors.forename: Marc
authors.initials: M
authors.lastname: Hermier
authors.forename: Patrice
authors.initials: P
authors.lastname: Adeleine
authors.forename: Frédéric
authors.initials: F
authors.lastname: Philippeau
authors.forename: Jérôme
authors.initials: J
authors.lastname: Honnorat
authors.forename: Hasan
authors.initials: H
authors.lastname: Yilmaz
authors.forename: Pascal
authors.initials: P
authors.lastname: Dardel
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Froment
authors.forename: Paul
authors.initials: P
authors.lastname: Trouillas
mesh_terms: D000208:Acute Disease; D000368:Aged; D002545:Brain Ischemia / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology*; D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000473:pathology; D015912:Thrombolytic Therapy / Q000009:adverse effects