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Cerebral microbleeds and risk of symptomatic hemorrhagic transformation following mechanical thrombectomy for large vessel ischemic stroke

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Abstract

Background and purpose

In patients with acute ischemic stroke (AIS) treated with endovascular therapy (EVT), the association of pre-existing cerebral small vessel disease (cSVD) with symptomatic intracerebral hemorrhage (sICH) remains controversial. We tested the hypothesis that the presence of cerebral microbleeds (CMBs) and their burden would be associated with sICH after EVT of AIS.

Methods

We conducted a retrospective study combining cohorts of patients that underwent EVT between January 1st 2015 and January 1st 2020. CMB presence, burden, and other cSVD markers were assessed on a pre-treatment MRI, evaluated independently by two observers. Primary outcome was the occurrence of sICH.

Results

445 patients with pretreatment MRI were included, of which 70 (15.7%) demonstrated CMBs on baseline MRI. sICH occurred in 36 (7.6%) of all patients. Univariate analysis did not demonstrate an association between CMB and the occurrence of sICH (7.5% in CMB+ group vs 8.6% in CMB group, p = 0.805). In multivariable models, CMBs’ presence was not significantly associated with increased odds for sICH (-aOR- 1.19; 95% CI [0.43–3.27], p = 0.73). Only ASPECTs (aOR 0.71 per point increase; 95% CI [0.60–0.85], p < 0.001) and collaterals status (aOR 0.22 for adequate versus poor collaterals; 95% CI [0.06–0.93], p 0.019) were independently associated with sICH.

Conclusion

CMB presence and burden is not associated with increased occurrence of sICH after EVT. This result incites not to exclude patients with CMBs from EVT. The risk of sICH after EVT in patients with more than10 CMBs will require further investigation.

Registration

Registration-URL: http://www.clinicaltrials.gov; Unique identifier: NCT01062698.

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Data availability

Data from this cohort shall be made available upon reasonable request by a qualified investigator to the corresponding author and after clearance by the local ethics committee.

Abbreviations

AIS:

Acute ischemic stroke

aOR:

Adjusted odds ratio

ASPECT:

Alberta Stroke Program Early CT

CMB:

Cerebral microbleeds

cSVD:

Cerebral small vessel disease

LVO:

Large vessel occlusion

mRS:

Modified Rankin scale

EVT:

Endovascular treatment

THRACE:

THRombectomie des Arteres CErebrales

WMH:

White matter hyperintensity

HT:

Hemorrhagic transformation

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Author notes

  1. Rémi Agbonon and Géraud Forestier equal participation as first authors.

Authors and Affiliations

  1. Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France

    Rémi Agbonon, Géraud Forestier, Wagih Benhassen, Joseph benzakoun, Laurence Legrand, Denis Trystram, Christine Rodriguez-Regent, Catherine Oppenheim, Olivier Naggara & Grégoire Boulouis

  2. Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France

    Rémi Agbonon, Géraud Forestier, Wagih Benhassen, Guillaume Turc, Joseph benzakoun, Pierre Seners, Laurence Legrand, Denis Trystram, Christine Rodriguez-Regent, Catherine Oppenheim, Olivier Naggara, Hilde Henon & Grégoire Boulouis

  3. Neuroradiology Department, Univ. Lille, Inserm, CHU Lille, U1172-LilNCog (JPARC)-Lille Neurosciences & Cognition, 59000, Lille, France

    Nicolas Bricout & Martin Bretzner

  4. Neurology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France

    Guillaume Turc, Pierre Seners & Hilde Henon

  5. Univ. Lille, Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience & Cognition, 59000, Lille, France

    Marco Pasi & Charlotte Cordonnier

  6. Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France

    Imad Derraz

  7. Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    Andreas Charidimou & Natalia S. Rost

  8. Neuroradiology Department, Lorraine University, INSERM U1254 CHRU Nancy, Nancy, France

    Serge Bracard

  9. Department of Neuroradiology of Pierre Wertheimer Hospital, Hospices Civils de Lyon, Lyon, France

    Omer F. Eker

  10. Neuroradiology Department, CHU de Tours, Centre Val de Loire Region, Tours, France

    Grégoire Boulouis

  11. Neuroradiology Department, Limoges University Hospital, 2 avenue Martin Luther-King, 87042, Limoges, France

    Géraud Forestier

Authors
  1. Rémi Agbonon
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  2. Géraud Forestier
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  3. Nicolas Bricout
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  16. Serge Bracard
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  18. Omer F. Eker
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  19. Catherine Oppenheim
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  20. Olivier Naggara
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  21. Hilde Henon
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  22. Grégoire Boulouis
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Corresponding author

Correspondence to Géraud Forestier.

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Agbonon, R., Forestier, G., Bricout, N. et al. Cerebral microbleeds and risk of symptomatic hemorrhagic transformation following mechanical thrombectomy for large vessel ischemic stroke. J Neurol 271, 2631–2638 (2024). https://doi.org/10.1007/s00415-024-12205-7

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