title: Risk of intracerebral hemorrhage in patients with cerebral microbleeds undergoing endovascular intervention.
abstract: OBJECTIVE
  Cerebral microbleeds (CMBs) on MRI gradient echo images are hemosiderin deposits, which may predict intracerebral hemorrhage (ICH). The risk of ICH in patients with CMBs could be exacerbated by the use of antithrombotics. The purpose of our study is to prospectively evaluate the risk of ICH in patients with ischemic stroke who receive dual antiplatelet therapy for endovascular intervention.
  
  
  METHODS
  We analyzed MRI of 133 patients admitted consecutively for intra- and extracranial stenting for symptomatic large artery atherosclerosis who received aspirin and clopidogrel. Quantity and location of CMBs were recorded by neuroradiologists independent from the angioplasty team. The primary end point was symptomatic ICH as evident in CT of the brain within 12 weeks of procedure.
  
  
  RESULTS
  CMBs were identified in 23 patients. Mean number of CMBs was 2.3 ± 1.6. Four patients had >5 CMBs. Forty-seven patients had intracranial stents, 84 patients had extracranial stents, and 2 patients had both intracranial and extracranial stents. There was no difference in risk of symptomatic ICH between those with (4.3%) and without CMBs (5.5%) patient with CMBs (P=1.000).
  
  
  CONCLUSIONS
  The presence of a small number of CMBs does not cause a large increase in the short-term risk of symptomatic ICH in patients with ischemic stroke who undergo endovascular intervention with dual antiplatelet therapy. The risk of ICH in patients with ≥ 5 CMBs, however, remains unclear. Further studies with a larger sample size of patients with multiple CMBs are needed.
authors.affiliation: Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Yannie O Y
authors.initials: YO
authors.lastname: Soo
authors.forename: Deyond Y W
authors.initials: DY
authors.lastname: Siu
authors.forename: Jill
authors.initials: J
authors.lastname: Abrigo
authors.forename: Simon
authors.initials: S
authors.lastname: Yu
authors.forename: Nick
authors.initials: N
authors.lastname: Ng
authors.forename: Anil T
authors.initials: AT
authors.lastname: Ahuja
authors.forename: Lawrence K S
authors.initials: LK
authors.lastname: Wong
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Leung
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects; D050197:Atherosclerosis / Q000628:therapy; D002545:Brain Ischemia / Q000150:complications / Q000628:therapy*; D002543:Cerebral Hemorrhage / Q000209:etiology*; D000077144:Clopidogrel; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000628:therapy*; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin