Incidence and Etiology of Microinfarcts in Patients with Ischemic Stroke

Oliveira‐Filho, Jamary; Ay, Hakan; Shoamanesh, Ashkan; Park, Kwang‐Yeol; Avery, Ross; Sorgun, Mine Hayriye; Kim, Gyeong‐Moon; Cougo, Pedro; Greenberg, Steven M.; Gurol, M. Edip

doi:10.1111/jon.12512

Cited by 13 publications

(17 citation statements)

References 29 publications

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“…[39][40][41] Apart from lacunes of presumed vascular origin, we did not find associations with CSVD markers such as WMH, microbleeds or brain atrophy. Associations of CMIs with WMH have been found in several studies, [12][13][14] but were absent in others. [6][7][8]37 Associations with cerebral microbleeds were similarly inconsistent, 7,8,11,12,14 as are the few results for brain atrophy.…”

Section: Discussionmentioning

confidence: 98%

“…17 Furthermore, CMIs' associations with risk factors such age, sex, smoking, alcohol use, hypertension, hyperlipidemia, and diabetes, are similarly inconsistent. [6][7][8][11][12][13][14] In addition, CMIs have been associated with ante mortem cognitive decline and dementia in autopsy studies. 2 A few neuroimaging studies have found similar associations in vivo.…”

Section: Introductionmentioning

confidence: 99%

“…Apart from studies in patients with cerebral amyloid angiopathy, associations with MRI features of CSVD are inconsistent. 6 – 8 , 10 – 15 Studies regarding cerebral perfusion and CMIs are few. 16 Only the microembolic etiology has substantial supporting evidence, by means of the association between carotid endarterectomy and acute CMIs.…”

Section: Introductionmentioning

confidence: 99%

“… 17 Furthermore, CMIs’ associations with risk factors such age, sex, smoking, alcohol use, hypertension, hyperlipidemia, and diabetes, are similarly inconsistent. 6 – 8 , 11 – 14 …”

Section: Introductionmentioning

confidence: 99%

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Cortical cerebral microinfarcts on 7T MRI: Risk factors, neuroimaging correlates and cognitive functioning – The Medea-7T study

Zwartbol

Rissanen

Ghaznawi

et al. 2021

J Cereb Blood Flow Metab

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We determined the occurrence and association of cortical cerebral microinfarcts (CMIs) at 7 T MRI with risk factors, neuroimaging markers of small and large vessel disease, and cognitive functioning. Within the Medea-7T study, a diverse cohort of older persons with normal cognition, patients with vascular disease, and memory clinic patients, we included 386 participants (68 ± 9 years) with available 7 T and 1.5 T/3T brain MRI, and risk factor and neuropsychological data. CMIs were found in 10% of participants and were associated with older age (RR = 1.79 per +10 years, 95%CI 1.28–2.50), history of stroke or TIA (RR = 4.03, 95%CI 2.18–7.43), cortical infarcts (RR = 5.28, 95%CI 2.91–9.55), lacunes (RR = 5.66, 95%CI 2.85–11.27), cerebellar infarcts (RR = 2.73, 95%CI 1.27–5.84) and decreased cerebral blood flow (RR = 1.35 per −100 ml/min, 95%CI 1.00–1.83), after adjustment for age and sex. Furthermore, participants with >2 CMIs had 0.5 SD (95%CI 0.05–0.91) lower global cognitive performance, compared to participants without CMIs. Our results indicate that CMIs on 7 T MRI are observed in vascular and memory clinic patients with similar frequency, and are associated with older age, history of stroke or TIA, other brain infarcts, and poorer global cognitive functioning.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“… 17 Furthermore, CMIs’ associations with risk factors such age, sex, smoking, alcohol use, hypertension, hyperlipidemia, and diabetes, are similarly inconsistent. 6 – 8 , 11 – 14 …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Cortical cerebral microinfarcts on 7T MRI: Risk factors, neuroimaging correlates and cognitive functioning – The Medea-7T study

Zwartbol

Rissanen

Ghaznawi

et al. 2021

J Cereb Blood Flow Metab

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“…All MRI images were independently rated by one primary rater (AS) as well as one secondary rater (JOF, FS, AM). The primary rater (AS) has previously demonstrated excellent interrater (AS and JOF; n = 40) agreement for the presence (Κ = 0.82, p < 0.001) and number (intraclass correlation coefficient = 0.85, p < 0.001) of DWIHLs [22]. The raters were blinded to baseline features, randomization, and outcomes.…”

Section: Imaging Acquisition and Analysismentioning

confidence: 99%

Intensive Blood Pressure Lowering and DWI Lesions in Intracerebral Hemorrhage: Exploratory Analysis of the ATACH-2 Randomized Trial

et al. 2021

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Background: With the increasing use of magnetic resonance imaging in the assessment of acute intracerebral hemorrhage, diffusion-weighted imaging hyperintense lesions have been recognized to occur at sites remote to the hematoma in up to 40% of patients. We investigated whether blood pressure reduction was associated with diffusionweighted imaging hyperintense lesions in acute intracerebral hemorrhage and whether such lesions are associated with worse clinical outcomes by analyzing imaging data from a randomized trial. Methods:We performed exploratory subgroup analyses in an open-label randomized trial that investigated acute blood pressure lowering in 1000 patients with intracerebral hemorrhage between May 2011 and September 2015. Eligible participants were assigned to an intensive systolic blood pressure target of 110-139 mm Hg versus 140-179 mm Hg with the use of intravenous nicardipine. Of these, 171 patients had requisite magnetic resonance imaging sequences for inclusion in these subgroup analyses. The primary outcome was the presence of diffusion-weighted imaging hyperintense lesions. Secondary outcomes included death or disability and serious adverse event at 90 days.Results: Diffusion-weighted imaging hyperintense lesions were present in 25% of patients (mean age 62 years). Hematoma volume > 30 cm 3 was an adjusted predictor (adjusted relative risk 2.41, 95% confidence interval 1.00-5.80) of lesion presence. Lesions occurred in 25% of intensively treated patients and 24% of standard treatment patients (relative risk 1.01, 95% confidence interval 0.71-1.43, p = 0.97). Patients with diffusion-weighted imaging hyperintense lesions had similar frequencies of death or disability at 90 days, compared with patients without lesions.Conclusions: Randomized assignment to intensive acute blood pressure lowering did not result in a greater frequency of diffusion-weighted imaging hyperintense lesion. Alternative mechanisms of diffusion-weighted imaging hyperintense lesion formation other than hemodynamic fluctuations need to be explored. Clinical trial registration ClinicalTrials.gov (Ref. NCT01176565; https:// clini caltr ials. gov/ ct2/ show/ NCT01 176565).

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Microbleeds and the Effect of Anticoagulation in Patients With Embolic Stroke of Undetermined Source

et al. 2021

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The reported associations of cerebral microbleeds with recurrent stroke and intracerebral hemorrhage have raised concerns regarding antithrombotic treatment in patients with a history of stroke and microbleeds on magnetic resonance imaging.OBJECTIVE To characterize microbleeds in embolic strokes of undetermined source (ESUS) and report interactions between microbleeds and the effects of random assignment to anticoagulant vs antiplatelet therapy.DESIGN, SETTING, AND PARTICIPANTS Subgroup analyses of the New Approach Rivaroxaban Inhibition of Factor Xa in a Global Trial vs Aspirin to Prevent Embolism in ESUS (NAVIGATE ESUS) international, double-blind, randomized, event-driven phase 3 clinical trial. Participants were enrolled between December 2014 and September 2017 and followed up for a median of 11 months. The study setting included 459 stroke recruitment centers in 31 countries. Patients aged 50 years or older who had neuroimaging-confirmed ESUS between 7 days and 6 months before screening were eligible. Of these 7213 NAVIGATE ESUS participants, 3699 (51%) had information on cerebral microbleeds reported on their baseline clinical magnetic resonance imaging and were eligible for these analyses. Patients with a prior history of symptomatic intracerebral hemorrhage were excluded from the NAVIGATE ESUS trial.INTERVENTIONS Rivaroxaban, 15 mg, compared with aspirin, 100 mg, daily. MAIN OUTCOMES AND MEASURESThe primary outcome was recurrent stroke. Secondary outcomes were ischemic stroke, intracerebral hemorrhage, and all-cause mortality.RESULTS Microbleeds were present in 395 of 3699 participants (11%). Of patients with cerebral microbleeds, mean (SD) age was 69.5 (9.4) years, 241 were men (61%), and 201 were White (51%). Advancing age (odds ratio [OR] per year, 1.03; 95% CI, 1.01-1.04), East Asian race/ethnicity (OR, 1.57; 95% CI, 1.04-2.37), hypertension (OR, 2.20; 95% CI,, multiterritorial infarcts (OR, 1.95; 95% CI, 1.42-2.67), chronic infarcts (OR, 1.78; 95% CI, 1.42-2.23), and occult intracerebral hemorrhage (OR, 5.23; 95% CI, 2.76-9.90) were independently associated with microbleeds. The presence of microbleeds was associated with a 1.5-fold increased risk of recurrent stroke (hazard ratio [HR], 1.5; 95% CI, 1.0-2.3), a 4-fold risk of intracerebral hemorrhage (HR, 4.2; 95% CI, 1.3-13.9), a 2-fold risk of all-cause mortality (HR, 2.1; 95% CI, 1.1-4.3), and strictly lobar microbleeds with an approximately 2.5-fold risk of ischemic stroke (HR, 2.3; 95% CI, 1.3-4.3). There were no interactions between microbleeds and treatment assignments for recurrent stroke, ischemic stroke, or all-cause mortality. The HR of intracerebral hemorrhage on rivaroxaban was similar between persons with microbleeds (HR, 3.1; 95% CI, 0.3-30.0) and persons without microbleeds (HR, 3.0; 95% CI, 0.6-14.7; interaction P = .97). CONCLUSIONS AND RELEVANCEMicrobleeds mark an increased risk of recurrent stroke, ischemic stroke, intracerebral hemorrhage, and mortality in ESUS but do not appear to influence effects of rivaroxaban on clinical out...

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Incidence and Etiology of Microinfarcts in Patients with Ischemic Stroke

Abstract: CMIs occurring within the vascular territory of a larger infarct are more likely embolic, but those occurring outside are probably related to SVD. Our findings suggest a role for SVD in pathogenesis of CMIs and emphasize the importance of etiologic workup to identify alternate etiologies.

Cited by 13 publications

References 29 publications

Cortical cerebral microinfarcts on 7T MRI: Risk factors, neuroimaging correlates and cognitive functioning – The Medea-7T study

Cortical cerebral microinfarcts on 7T MRI: Risk factors, neuroimaging correlates and cognitive functioning – The Medea-7T study

Intensive Blood Pressure Lowering and DWI Lesions in Intracerebral Hemorrhage: Exploratory Analysis of the ATACH-2 Randomized Trial

Microbleeds and the Effect of Anticoagulation in Patients With Embolic Stroke of Undetermined Source

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