Exploring the Impact of Cerebral Microbleeds on Stroke Management

Abstract

Stroke constitutes a major cause of functional disability and mortality, with increasing prevalence. Thus, the timely and accurate prognosis of stroke outcomes based on clinical or radiological markers is vital for both physicians and stroke survivors. Among radiological markers, cerebral microbleeds (CMBs) constitute markers of blood leakage from pathologically fragile small vessels. In the present review, we evaluated whether CMBs affect ischemic and hemorrhagic stroke outcomes and explored the fundamental question of whether CMBs may shift the risk–benefit balance away from reperfusion therapy or antithrombotic use in acute ischemic stroke patients. A literature review of two databases (MEDLINE and Scopus) was conducted to identify all the relevant studies published between 1 January 2012 and 9 November 2022. Only full-text articles published in the English language were included. Forty-one articles were traced and included in the present review. Our findings highlight the utility of CMB assessments, not only in the prognostication of hemorrhagic complications of reperfusion therapy, but also in forecasting hemorrhagic and ischemic stroke patients’ functional outcomes, thus indicating that a biomarker-based approach may aid in the provision of counseling for patients and families, improve the selection of more appropriate medical therapies, and contribute to a more accurate choice of patients for reperfusion therapy.

Prevalence and Impact of Cerebral Microbleeds on Clinical and Safety Outcomes in Acute Ischaemic Stroke Patients Receiving Reperfusion Therapy: A Systematic Review and Meta-Analysis

“…Our study confirms that CMBs are associated with worse clinical outcomes following reperfusion therapy, consistent with findings reported in previous meta-analyses [85,87]. Our findings show that there is a negative association between CMBs in AIS patients who underwent reperfusion therapy and worse clinical outcomes such as 90-day poor functional outcome (mRS 3-6) and 90-day mortality.…”

“…In terms of adverse outcomes, our study suggests that AIS patients with CMBs are associated with increased odds of sICH and HT. This aligns with previous studies, in which the presence of CMBs were associated with sICH and HT [49,87]. Prior CMBs are generally associated with microangiopathy in the brain, making it prone to haemorrhage and thus sICH or HT [88].…”

Prevalence and Risk Factors of Cerebral Microbleeds in Community-Dwelling Adults in Urban Delhi

“…Studies suggest individuals with CMBs have a higher risk of experiencing stroke (both hemorrhagic and ischemic) and potentially worse stroke outcomes like increased disability or mortality. [ 1 2 ] Previous studies also indicate a possible link between CMBs and cognitive decline, particularly in memory and executive function, which might contribute to dementia development. [ 3 ] These findings highlight the potential clinical significance of CMBs, warranting further investigation into the underlying mechanisms and the potential benefits of interventions targeting CMB prevention or management.…”

Monocyte to HDL and Neutrophil to HDL Ratios as Potential Ischemic Stroke Prognostic Biomarkers

“…The socioeconomic burden of stroke survivors will increase at an unprecedented rate due to the age-related character of the disease, the fact that more than half of patients are over 65 [ 3 , 4 , 5 ], the growing worldwide population and the ongoing improvement in life expectancy. Therefore, it is crucial to identify patients with poor prognoses early and precisely in order to customize treatment and rehabilitation to meet the needs of each individual [ 6 , 7 , 8 ].…”