Thrombolysis for ischemic stroke in patients with old microbleeds on pretreatment MRI.
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.
Derex
Laurent
L
Service d'Urgences Neurovasculaires, Hôpital Neurologique, Hospices Civils de Lyon, Lyon, France. laurent.derex@chu-lyon.fr
Nighoghossian
Norbert
N
Hermier
Marc
M
Adeleine
Patrice
P
Philippeau
Frédéric
F
Honnorat
Jérôme
J
Yilmaz
Hasan
H
Dardel
Pascal
P
Froment
Jean-Claude
JC
Trouillas
Paul
P
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