Abstract Details

Title Cerebral Microbleed Burden Predicts Symptomatic Intracerebral Hemorrhage Following Thrombolysis

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) IN7 - (-)

Poster/Presentation
Number 008

Objective

Background It has been questioned whether patients with CMBs are at a greater risk for the development of symptomatic intracerebral hemorrhage (sICH) following thrombolytic therapy in the management of acute ischemic stroke. Thus far, observational studies have not shown a statistically significant increased risk, however these have been limited by small sample size.

Design/Methods A systematic review of controlled studies investigating the presence of CMBs on MRI as a risk factor for ICH following thrombolysis in acute stroke patients was conducted. CMB burden was graded as either absent, 1-2 CMBs, 3-10 CMBs or >10 CMBs. A random effects model meta-analysis was performed.

Results In pooled analysis of five studies totaling 790 participants, the prevalence of CMBs was 17%. The presence of CMBs was associated with a trend towards an increased risk of post-thrombolysis sICH [OR: 1.98 (95% CI, 0.90 to 4.35; p=0.09), I2= 0%]. Adjusted analysis minimizing potential bias resulted in an increased absolute risk of 4.6% for the development of sICH in patients with CMBs [OR: 2.29 (95% CI, 1.01 to 5.17), I2= 0%], which reached borderline significance (p=0.05). A significant dose-dependent relationship between increasing CMB burden and sICH was observed (p=0.0015). This risk was most substantial in patients with >10 CMBs, with 29% experiencing sICH [OR 12.18 (95% CI, 1.67 to 88.70; p=0.01), I2=7%]. Isolated analysis of studies using exclusively intravenous tissue plasminogen activator was insignificant.

Conclusions Our analysis suggests that patients with CMBs are at increased risk for sICH following thrombolysis for acute ischemic stroke. However, current data is insufficient to justify withholding thrombolytic therapy from acute ischemic stroke patients solely on the basis of CMB presence.

Authors/Disclosures
Ashkan Shoamanesh, MD PRESENTER	Dr. Shoamanesh has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bayer AG. Dr. Shoamanesh has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Daiichi Sankyo . Dr. Shoamanesh has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Servier Inc.. Dr. Shoamanesh has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurodiem.ca. The institution of Dr. Shoamanesh has received research support from Servier Canada Inc.. The institution of Dr. Shoamanesh has received research support from Daiichi Sankyo Ltd.. The institution of Dr. Shoamanesh has received research support from Bayer AG. The institution of Dr. Shoamanesh has received research support from Bristol-Myers Squibb. The institution of Dr. Shoamanesh has received research support from Octapharma Canada .
Chun Kwok	No disclosure on file
Patricia A. Lim, MD	No disclosure on file
Oscar R. Benavente, MD, FRCP(C) (Gordon and Leslie Diamond Health Care Centre)	No disclosure on file
Wolfgang Singer, MD, FAAN (Mayo Clinic)	Dr. Singer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amneal. Dr. Singer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UniQure. Dr. Singer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biohaven. Dr. Singer has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Theravance. The institution of Dr. Singer has received research support from NIH. The institution of Dr. Singer has received research support from FDA. The institution of Dr. Singer has received research support from Michael J. Fox Foundation. Dr. Singer has received intellectual property interests from a discovery or technology relating to health care.
Wolfgang Singer, MD, FAAN (Mayo Clinic)	Dr. Singer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amneal. Dr. Singer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UniQure. Dr. Singer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biohaven. Dr. Singer has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Theravance. The institution of Dr. Singer has received research support from NIH. The institution of Dr. Singer has received research support from FDA. The institution of Dr. Singer has received research support from Michael J. Fox Foundation. Dr. Singer has received intellectual property interests from a discovery or technology relating to health care.
Hooman Kamel, MD (Weill Cornell Medical College)	Dr. Kamel has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JAMA Neurology. Dr. Kamel has received personal compensation in the range of $50,000-$99,999 for serving as a Endpoint adjudication committee with Boehringer-Ingelheim.

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