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Pretreatment cerebral microbleeds and symptomatic intracerebral hemorrhage post-thrombolysis: a systematic review and meta-analysis

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Abstract

Background and purpose

Cerebral microbleeds (CMBs) are a possible predictor of symptomatic intracranial hemorrhage (sICH) and poor function outcome (PFO). We aimed to investigate the presence of CMBs on increased incidence of sICH and PFO in acute ischemic stroke patients receiving intravenous thrombolysis (IVT) treatment.

Methods

We searched PubMed, EMBASE, and Cochrane Library from 1 January 1997 to 13 May 2018, for relevant studies and calculated the pooled relative risk (RR) for the incidence of sICH and PFO in patients with CMBs versus those without after IVT.

Results

We included 2407 participants from nine studies. The cumulative sICH incidence was higher in patients with CMBs (6%, 95% CI 4–8%) than that in patients without CMBs (4%, 95% CI 2–6%) with pooled RR 1.51 (95% CI, 1.04–2.21; P = 0.031). Four studies including 1550 patients reported data on 3- to 6-month PFO. The cumulative PFO incidence was higher in patients with CMBs (53%, 95% CI 47–59%) than that in patients without CMBs (41%, 95% CI 36–46%) with pooled RR 1.25 (95% CI 1.11–1.41; P = 0.000).

Conclusions

The pretreatment CMBs were associated with increased incidence of sICH and PFO in acute ischemic stroke patients receiving IVT. However, it was not convincing enough to set the presence of CMBs as contraindication to IVT.

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Authors and Affiliations

  1. Department of Neurology, Cerebrovascular Disease Center, People’s Hospital, China Medical University, 33 Wenyi Road, Shenhe District, Shenyang, 110016, People’s Republic of China

    Jiangzhi Yan, Jianting Qiu, Xiumei Wu, Yonggui Ge, Jian Wang & Yujie Wang

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  1. Jiangzhi Yan
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  2. Jianting Qiu
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  3. Xiumei Wu
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  4. Yonggui Ge
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  5. Jian Wang
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  6. Yujie Wang
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Correspondence to Yujie Wang.

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The study authors received no funding and report no conflicts of interest.

Ethical standards

All studies in this review have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Yan, J., Qiu, J., Wu, X. et al. Pretreatment cerebral microbleeds and symptomatic intracerebral hemorrhage post-thrombolysis: a systematic review and meta-analysis. J Neurol 267, 301–307 (2020). https://doi.org/10.1007/s00415-018-9156-5

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  • DOI: https://doi.org/10.1007/s00415-018-9156-5

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