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Outcomes of patients with cerebral microbleeds undergoing percutaneous coronary intervention and dual antiplatelet therapy

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Introduction: Cerebral microbleeds (CMBs) on brain magnetic resonance imaging (MRI) are predictive of intracerebral hemorrhage (ICH). However, the risk of ICH in patients with CMBs who undergo percutaneous coronary intervention (PCI) while receiving dual antiplatelet therapy (DAPT) is unclear. Materials and methods: We conducted a study on 329 consecutive patients with coronary artery disease who underwent PCI and were evaluated using a 3T MRI scanner. Based on T2*-weighted imaging, patients were classified into three groups: no CMBs, < 5 CMBs, or ≥ 5 CMBs. We determined the occurrence of ICH during follow-up. Results: At least 1 CMB was found in 109 (33%) patients. The mean number of CMBs per patient was 2.9 ± 3.6. Among the 109 patients with CMBs, 16 (15%) had ≥ 5 CMBs. Coronary stent implantation was performed in 321 patients (98%). DAPT was prescribed for 325 patients (99%). During a mean follow-up period of 2.3 years (interquartile range, 1.9–2.5 years), ICH occurred in one patient (1.1%) with four CMBs. There were no significant differences in the incidence of ICH (0% vs. 1.1% vs. 0%; p = 0.28). However, the rate of DAPT at 6 months of follow-up was significantly lower in patients with ≥ 5 CMBs than in patients with no CMBs or < 5 CMBs (89% vs. 91% vs. 66%, p = 0.026). Furthermore, there were no significant differences in systemic blood pressure during follow-up (123 ± 16 vs. 125 ± 16 vs. 118 ± 11 mmHg; p = 0.40). Conclusion: Although a substantial number of patients who underwent PCI had cerebral microbleeds, at approximately two years of follow-up, intracerebral hemorrhage was very rare in our study population.

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Acknowledgements

None.

Funding

The Intramural Research Fund for Cardiovascular disease of the National Cerebral and Cardiovascular Center (23-B-7).

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Suita, Osaka, Japan

    Masashi Fujino, Teruo Noguchi, Fumiyuki Otsuka, Yu Kataoka & Yasuhide Asaumi

  2. Stroke and Cerebrovascular Disease, Suita, Osaka, Japan

    Takako Torii-Yoshimura

  3. Department of Primary Care and Emergency Medicine/Healthcare Epidemiology, Kyoto university, Kyoto, Japan

    Yoshinori Okuno

  4. Radiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan

    Yoshiaki Morita

  5. Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan

    Kunihiro Nishimura

  6. Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan

    Hiroshi Yamagami

  7. Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan

    Satoshi Yasuda

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  1. Masashi Fujino
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Correspondence to Masashi Fujino.

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Conflict of interest

MF is supported by a Grant-in-Aid for Young Scientists from the Japan Society for the Promotion of Science (20K17138) and a grant from Bristol-Myers Squibb, both unrelated to this study. HY has received grants from Bristol-Myers Squibb and lecturer fees from Bayer, Bristol-Myers Squibb, Daiichi Sankyo, and Otsuka Pharmaceutical unrelated to this study.

Ethics approval

The study protocol was approved by the institutional review board of the National Cerebral and Cardiovascular Center (M26-044). The study was conducted in accordance with regulations governing epidemiological studies issued by the Ministry of Health, Labour and Welfare of Japan.

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Fujino, M., Noguchi, T., Torii-Yoshimura, T. et al. Outcomes of patients with cerebral microbleeds undergoing percutaneous coronary intervention and dual antiplatelet therapy. Heart Vessels (2024). https://doi.org/10.1007/s00380-024-02404-7

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