New Cerebral Microbleeds After Mechanical Thrombectomy for Large-Vessel Occlusion Strokes

Abstract

The interval appearance of cerebral microbleeds (CMBs) after endovascular treatment has never been described. We investigated the frequency and predictors of new CMBs that developed shortly after mechanical thrombectomy for acute ischemic stroke, and its impact on clinical outcome.We retrospectively analyzed patients with large-vessel occlusion strokes treated with Merci Retriever, Penumbra System, or stent-retriever devices. Serial T2∗-weighted gradient-recall echo (GRE) magnetic resonance imaging (MRI) before and 48 h after endovascular thrombectomy were assessed to identify new CMBs. We examined independent factors associated with new CMBs after mechanical thrombectomy. We analyzed the association of the presence, burden, and distribution of new CMBs with clinical outcome.A total of 187 consecutive patients with serial GRE were enrolled in this study. CMBs were evident in 36 (19.3%) patients before mechanical thrombectomy. New CMBs occurred in 41 (21.9%) patients after mechanical thrombectomy. Of the 68 new CMBs, 45 appeared in the lobar location, 18 in the deep location and 5 in the infratentorial location. The presence of baseline CMBs was associated with new CMBs after mechanical thrombectomy (OR 5.38; 95% CI 2.13–13.59; P < 0.001), no matter whether the patients were treated primarily with mechanical thrombectomy or with intravenous thrombolysis followed by mechanical thrombectomy. Patients with new CMBs did not have increased rates of hemorrhagic transformation, in-hospital mortality, and modified Rankin Scale score 4 to 6 at discharge.New CMBs are common after mechanical thrombectomy in one-fifth of patients with acute ischemic stroke. Baseline CMBs before mechanical thrombectomy predicts the development of new CMBs. New CMBs after mechanical thrombectomy do not influence clinical outcome.

Renal Impairment Is Associated with Intracerebral Hemorrhage after Mechanical Thrombectomy in Vertebrobasilar Stroke

“…Moreover, new cerebral microbleeds can be observed frequently after mechanical thrombectomy [9] and they represent a risk factor for ICH after acute stroke treatments [10]. It appears plausible that cerebral microbleeds may have contributed to our findings.…”

“…Of note, patients with RD are prone to have strokes in the posterior circulation [6], and RD is associated with higher frequencies of deep cerebral microbleeds [7,8]. Moreover, new cerebral microbleeds can be observed frequently after mechanical thrombectomy [9], and cerebral microbleeds represent a risk factor for subsequent ICH after acute stroke treatments [10]. Therefore, RD may represent a risk factor for ICH and worse clinical outcome after stroke thrombectomy particularly in patients with vertebrobasilar stroke.…”

NADPH oxidase inhibitor improves outcome of mechanical reperfusion by suppressing hemorrhagic transformation

“…However, rapid reperfusion may lead to reperfusion injury and hemorrhagic transformation (HT) in acute stroke 4 5. Minor HT is usually inconsequential, but the parenchymal hematoma has been shown to be associated with a poor clinical outcome 3 6 7. Preventing severe HT is the next frontier of stroke intervention.…”

Effect of small vessel disease severity on blood pressure management after endovascular therapy in theBP TARGETtrial

“…Fourthly, CSVD burden was assessed either on the baseline MRI for patients included with this modality or on the MRI performed at 24 h for patients without a baseline MRI. As recent observational studies reported the appearance of new CMBs after EVT [37], CMB assessment using pre‐ and post‐EVT MRI could have biased our results. That said, only two patients had CMBs assessed on the post‐EVT MRI at 24 h. Therefore, our findings mainly concern CSVD assessment on the pre‐EVT MRI performed in the acute phase.…”