title: Mechanical thrombectomy for acute ischemic stroke with cerebral microbleeds.
abstract: BACKGROUND
  The influence of cerebral microbleeds (CMBs) on post-thrombolytic hemorrhagic transformation (HT) in patients with acute ischemic stroke remains controversial.
  
  
  OBJECTIVE
  To investigate the association of CMBs with HT and clinical outcomes among patients with large-vessel occlusion strokes treated with mechanical thrombectomy.
  
  
  METHODS
  We analyzed patients with acute stroke treated with Merci Retriever, Penumbra system or stent-retriever devices. CMBs were identified on pretreatment T2-weighted, gradient-recall echo MRI. We analyzed the association of the presence, burden, and distribution of CMBs with HT, procedural complications, in-hospital mortality, and clinical outcome.
  
  
  RESULTS
  CMBs were detected in 37 (18.0%) of 206 patients. Seventy-three foci of microbleeds were identified. Fourteen patients (6.8%) had ≥2 CMBs, only 1 patient had ≥5 CMBs. Strictly lobar CMBs were found in 12 patients, strictly deep CMBs in 12 patients, strictly infratentorial CMBs in 2 patients, and mixed CMBs in 11 patients. There were no significant differences between patients with CMBs and those without CMBs in the rates of overall HT (37.8% vs 45.6%), parenchymal hematoma (16.2% vs 19.5%), procedure-related vessel perforation (5.4% vs 7.1%), in-hospital mortality (16.2% vs 18.3%), and modified Rankin Scale score 0-3 at discharge. CMBs were not independently associated with HT or in-hospital mortality in patients treated with either thrombectomy or intravenous thrombolysis followed by thrombectomy.
  
  
  CONCLUSIONS
  Patients with CMBs are not at increased risk for HT and mortality following mechanical thrombectomy for acute stroke. Excluding such patients from mechanical thrombectomy is unwarranted. The risk of HT in patients with ≥5 CMBs requires further study.
authors.affiliation: Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Zhong-Song
authors.initials: ZS
authors.lastname: Shi
authors.affiliation: Division of Interventional Neuroradiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Gary R
authors.initials: GR
authors.lastname: Duckwiler
authors.affiliation: Division of Interventional Neuroradiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Reza
authors.initials: R
authors.lastname: Jahan
authors.affiliation: Division of Interventional Neuroradiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Tateshima
authors.affiliation: Division of Interventional Neuroradiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Nestor R
authors.initials: NR
authors.lastname: Gonzalez
authors.affiliation: Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Viktor
authors.initials: V
authors.lastname: Szeder
authors.affiliation: Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Saver
authors.affiliation: Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Doojin
authors.initials: D
authors.lastname: Kim
authors.affiliation: Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Latisha K
authors.initials: LK
authors.lastname: Ali
authors.affiliation: Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Sidney
authors.initials: S
authors.lastname: Starkman
authors.affiliation: Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Vespa
authors.affiliation: Division of Diagnostic Neuroradiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Noriko
authors.initials: N
authors.lastname: Salamon
authors.affiliation: Division of Diagnostic Neuroradiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: J Pablo
authors.initials: JP
authors.lastname: Villablanca
authors.affiliation: Division of Interventional Neuroradiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Fernando
authors.initials: F
authors.lastname: Viñuela
authors.affiliation: Department of Radiology, Kaiser Permanente Medical Center, Los Angeles, California, USA.
authors.forename: Lei
authors.initials: L
authors.lastname: Feng
authors.affiliation: Interventional Neuroradiology and Neurocritical Care Services, Madigan Army Medical Center, Tacoma, Washington, USA.
authors.forename: Yince
authors.initials: Y
authors.lastname: Loh
authors.affiliation: Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA Neurovascular Imaging Research Core, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality; D002561:Cerebrovascular Disorders / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D017131:Thrombectomy / Q000009:adverse effects / Q000379:methods*
keywords: Hemorrhage; Stroke; Thrombectomy