title: New Cerebral Microbleeds After Mechanical Thrombectomy for Large-Vessel Occlusion Strokes.
abstract: The interval appearance of cerebral microbleeds (CMBs) after endovascular treatment has never been described. We investigated the frequency and predictors of new CMBs that developed shortly after mechanical thrombectomy for acute ischemic stroke, and its impact on clinical outcome.We retrospectively analyzed patients with large-vessel occlusion strokes treated with Merci Retriever, Penumbra System, or stent-retriever devices. Serial T2*-weighted gradient-recall echo (GRE) magnetic resonance imaging (MRI) before and 48 h after endovascular thrombectomy were assessed to identify new CMBs. We examined independent factors associated with new CMBs after mechanical thrombectomy. We analyzed the association of the presence, burden, and distribution of new CMBs with clinical outcome.A total of 187 consecutive patients with serial GRE were enrolled in this study. CMBs were evident in 36 (19.3%) patients before mechanical thrombectomy. New CMBs occurred in 41 (21.9%) patients after mechanical thrombectomy. Of the 68 new CMBs, 45 appeared in the lobar location, 18 in the deep location and 5 in the infratentorial location. The presence of baseline CMBs was associated with new CMBs after mechanical thrombectomy (OR 5.38; 95% CI 2.13-13.59; P < 0.001), no matter whether the patients were treated primarily with mechanical thrombectomy or with intravenous thrombolysis followed by mechanical thrombectomy. Patients with new CMBs did not have increased rates of hemorrhagic transformation, in-hospital mortality, and modified Rankin Scale score 4 to 6 at discharge.New CMBs are common after mechanical thrombectomy in one-fifth of patients with acute ischemic stroke. Baseline CMBs before mechanical thrombectomy predicts the development of new CMBs. New CMBs after mechanical thrombectomy do not influence clinical outcome.
authors.affiliation: From the Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (Z-SS); Division of Interventional Neuroradiology (GRD, RJ, ST, NRG, VS, FV), Department of Neurology (JLS, DK, LKA, SS, DSL), Department of Emergency Medicine (SS), Department of Neurosurgery (NRG, PMV), Division of Diagnostic Neuroradiology (NS, JPV), and Neurovascular Imaging Research Core (DSL), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Radiology, Kaiser Permanente Medical Center, Los Angeles, CA (LF); Interventional Neuroradiology and Neurocritical Care Services, Madigan Army Medical Center, Tacoma, WA (YL), Guangdong Province Key Laboratory of Brain Function and Disease, Sun Yat-sen University, Guangzhou, China (Z-SS).
authors.forename: Zhong-Song
authors.initials: ZS
authors.lastname: Shi
authors.forename: Gary R
authors.initials: GR
authors.lastname: Duckwiler
authors.forename: Reza
authors.initials: R
authors.lastname: Jahan
authors.forename: Satoshi
authors.initials: S
authors.lastname: Tateshima
authors.forename: Nestor R
authors.initials: NR
authors.lastname: Gonzalez
authors.forename: Viktor
authors.initials: V
authors.lastname: Szeder
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Saver
authors.forename: Doojin
authors.initials: D
authors.lastname: Kim
authors.forename: Latisha K
authors.initials: LK
authors.lastname: Ali
authors.forename: Sidney
authors.initials: S
authors.lastname: Starkman
authors.forename: Paul M
authors.initials: PM
authors.lastname: Vespa
authors.forename: Noriko
authors.initials: N
authors.lastname: Salamon
authors.forename: J Pablo
authors.initials: JP
authors.lastname: Villablanca
authors.forename: Fernando
authors.initials: F
authors.lastname: Viñuela
authors.forename: Lei
authors.initials: L
authors.lastname: Feng
authors.forename: Yince
authors.initials: Y
authors.lastname: Loh
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000098:blood supply*; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000601:surgery*; D017131:Thrombectomy / Q000009:adverse effects* / Q000379:methods