Association between cerebral microbleeds and prior primary intracerebral hemorrhage in ischemic stroke patients

2008 ◽  
Vol 110 (10) ◽  
pp. 988-991 ◽  
Author(s):  
Ying-Fa Chen ◽  
Yung-Yee Chang ◽  
Jia-Shou Liu ◽  
Chun-Chung Lui ◽  
Yi-Fen Kao ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Cerebral Microbleeds ◽  
Stroke Patients

Acute intracranial stenting with mechanical thrombectomy is safe and efficacious in patients diagnosed with underlying intracranial atherosclerotic disease

2021 ◽  
pp. 159101992110394
Author(s):  
Ameer E Hassan ◽  
Victor M Ringheanu ◽  
Laurie Preston ◽  
Wondwossen G Tekle ◽  
Adnan I Qureshi
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Intracerebral Hemorrhage ◽  
Cerebral Infarction ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Intracranial Stenting ◽  
Intracranial Atherosclerotic Disease

Objective To investigate whether significant differences exist in recanalization rates and primary outcomes between patients who undergo mechanical thrombectomy alone versus those who undergo mechanical thrombectomy with acute intracranial stenting. Methods Through the utilization of a prospectively collected endovascular database at a comprehensive stroke center between 2012 and 2020, variables such as demographics, co-morbid conditions, symptomatic intracerebral hemorrhage, mortality rate at discharge, and good/poor outcomes in regard to modified thrombolysis in cerebral infarction score and modified Rankin Scale were examined. The outcomes between patients receiving acute intracranial stenting + mechanical thrombectomy and patients that underwent mechanical thrombectomy alone were compared. Results There were a total of 420 acute ischemic stroke patients who met criteria for the study (average age 70.6 ± 13.01 years; 46.9% were women). Analysis of 46 patients from the acute stenting + mechanical thrombectomy group (average age 70.34 ± 13.75 years; 37.0% were women), and 374 patients from the mechanical thrombectomy alone group (average age 70.64 ± 12.92 years; 48.1% were women). Four patients (8.7%) in the acute stenting + mechanical thrombectomy group experienced intracerebral hemorrhage versus 45 patients (12.0%) in the mechanical thrombectomy alone group ( p = 0.506); no significant increases were noted in the median length of stay (7 vs 8 days; p = 0.208), rates of modified thrombolysis in cerebral infarction 2B-3 recanalization ( p = 0.758), or good modified Rankin Scale scores ( p = 0.806). Conclusion Acute intracranial stenting in addition to mechanical thrombectomy was not associated with an increase in overall length of stay, intracerebral hemorrhage rates, or any change in discharge modified Rankin Scale. Further research is required to determine whether mechanical thrombectomy and acute intracranial stenting in acute ischemic stroke patients is unsafe.

scholarly journals Clinical significance of cerebral microbleeds on MRI: A comprehensive meta-analysis of risk of intracerebral hemorrhage, ischemic stroke, mortality, and dementia in cohort studies (v1)

2018 ◽  
Vol 13 (5) ◽  
pp. 454-468 ◽  
Author(s):  
Andreas Charidimou ◽  
Sara Shams ◽  
Jose R Romero ◽  
Jie Ding ◽  
Roland Veltkamp ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
High Risk ◽  
Intracerebral Hemorrhage ◽  
Meta Analysis ◽  
Population Based ◽  
Cerebral Microbleeds ◽  
Clinical Settings ◽  
Memory Clinic ◽  
Increased Risk ◽  
Stroke Death

Background Cerebral microbleeds can confer a high risk of intracerebral hemorrhage, ischemic stroke, death and dementia, but estimated risks remain imprecise and often conflicting. We investigated the association between cerebral microbleeds presence and these outcomes in a large meta-analysis of all published cohorts including: ischemic stroke/TIA, memory clinic, “high risk” elderly populations, and healthy individuals in population-based studies. Methods Cohorts (with > 100 participants) that assessed cerebral microbleeds presence on MRI, with subsequent follow-up (≥3 months) were identified. The association between cerebral microbleeds and each of the outcomes (ischemic stroke, intracerebral hemorrhage, death, and dementia) was quantified using random effects models of (a) unadjusted crude odds ratios and (b) covariate-adjusted hazard rations. Results We identified 31 cohorts ( n = 20,368): 19 ischemic stroke/TIA ( n = 7672), 4 memory clinic ( n = 1957), 3 high risk elderly ( n = 1458) and 5 population-based cohorts ( n = 11,722). Cerebral microbleeds were associated with an increased risk of ischemic stroke (OR: 2.14; 95% CI: 1.58–2.89 and adj-HR: 2.09; 95% CI: 1.71–2.57), but the relative increase in future intracerebral hemorrhage risk was greater (OR: 4.65; 95% CI: 2.68–8.08 and adj-HR: 3.93; 95% CI: 2.71–5.69). Cerebral microbleeds were an independent predictor of all-cause mortality (adj-HR: 1.36; 95% CI: 1.24–1.48). In three population-based studies, cerebral microbleeds were independently associated with incident dementia (adj-HR: 1.35; 95% CI: 1.00–1.82). Results were overall consistent in analyses stratified by different populations, but with different degrees of heterogeneity. Conclusions Our meta-analysis shows that cerebral microbleeds predict an increased risk of stroke, death, and dementia and provides up-to-date effect sizes across different clinical settings. These pooled estimates can inform clinical decisions and trials, further supporting cerebral microbleeds role as biomarkers of underlying subclinical brain pathology in research and clinical settings.

Cerebral Microbleeds are Associated with Higher Mortality Among Ischemic Stroke Patients

2018 ◽  
Vol 27 (11) ◽  
pp. 3036-3042 ◽  
Author(s):  
Ramin Zand ◽  
Shima Shahjouei ◽  
Georgios Tsivgoulis ◽  
Mantinderpreet Singh ◽  
Michael McCormack ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cerebral Microbleeds ◽  
Stroke Patients

scholarly journals Mechanical Thrombectomy in Ischemic Stroke Patients With Alberta Stroke Program Early Computed Tomography Score 0–5

Stroke ◽  
2019 ◽  
Vol 50 (4) ◽  
pp. 880-888 ◽  
Author(s):  
Johannes Kaesmacher ◽  
Panagiotis Chaloulos-Iakovidis ◽  
Leonidas Panos ◽  
Pasquale Mordasini ◽  
Patrik Michel ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Mechanical Thrombectomy ◽  
Functional Independence ◽  
Favorable Outcome ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Symptomatic Intracerebral Hemorrhage

Background and Purpose— If anterior circulation large vessel occlusion acute ischemic stroke patients presenting with ASPECTS 0–5 (Alberta Stroke Program Early CT Score) should be treated with mechanical thrombectomy remains unclear. Purpose of this study was to report on the outcome of patients with ASPECTS 0–5 treated with mechanical thrombectomy and to provide data regarding the effect of successful reperfusion on clinical outcomes and safety measures in these patients. Methods— Multicenter, pooled analysis of 7 institutional prospective registries: Bernese-European Registry for Ischemic Stroke Patients Treated Outside Current Guidelines With Neurothrombectomy Devices Using the SOLITAIRE FR With the Intention for Thrombectomy (Clinical Trial Registration—URL: https://www.clinicaltrials.gov . Unique identifier: NCT03496064). Primary outcome was defined as modified Rankin Scale 0–3 at day 90 (favorable outcome). Secondary outcomes included rates of day 90 modified Rankin Scale 0–2 (functional independence), day 90 mortality and occurrence of symptomatic intracerebral hemorrhage. Multivariable logistic regression analyses were performed to assess the association of successful reperfusion with clinical outcomes. Outputs are displayed as adjusted Odds Ratios (aOR) and 95% CI. Results— Two hundred thirty-seven of 2046 patients included in this registry presented with anterior circulation large vessel occlusion and ASPECTS 0–5. In this subgroup, the overall rates of favorable outcome and mortality at day 90 were 40.1% and 40.9%. Achieving successful reperfusion was independently associated with favorable outcome (aOR, 5.534; 95% CI, 2.363–12.961), functional independence (aOR, 5.583; 95% CI, 1.964–15.873), reduced mortality (aOR, 0.180; 95% CI, 0.083–0.390), and lower rates of symptomatic intracerebral hemorrhage (aOR, 0.235; 95% CI, 0.062–0.887). The mortality-reducing effect remained in patients with ASPECTS 0–4 (aOR, 0.167; 95% CI, 0.056–0.499). Sensitivity analyses did not change the primary results. Conclusions— In patients presenting with ASPECTS 0–5, who were treated with mechanical thrombectomy, successful reperfusion was beneficial without increasing the risk of symptomatic intracerebral hemorrhage. Although the results do not allow for general treatment recommendations, formal testing of mechanical thrombectomy versus best medical treatment in these patients in a randomized controlled trial is warranted.

Risk Scores for Predicting Post–thrombolysis Intracerebral Hemorrhage

US Neurology ◽  
2010 ◽  
Vol 05 (02) ◽  
pp. 39 ◽  
Author(s):  
James S McKinney ◽  
Brett Cucchiara ◽  
◽  
Keyword(s):  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Acute Ischemic Stroke ◽  
Clinical Assessment ◽  
Scoring Systems ◽  
Risk Scores ◽  
Stroke Patients ◽  
Factors Associated

Post-thrombolysis hemorrhage is a major concern for physicians treating acute ischemic stroke. Two scoring systems that incorporate factors associated with post-thrombolysis hemorrhage have been developed in an attempt to estimate the risk of developing post-thrombolysis hemorrhage among stroke patients. In this article we discuss these scoring systems and their utility in the clinical assessment of stroke patients.

scholarly journals PREDIKTOR SYMPTOMATIC INTRACEREBRAL HEMORRHAGE PASCATROMBOLISIS INTRAVENA PADA STROKE ISKEMIK AKUT

2018 ◽  
Vol 35 (3) ◽  
Author(s):  
Al Rasyid ◽  
Salim Harris ◽  
Mohammad Kurniawan ◽  
Rakhmad Hidayat ◽  
Taufik Mesiano
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Intravenous Thrombolysis ◽  
Definitive Treatment ◽  
Stroke Patients ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Stroke Thrombolysis ◽  
Withholding Therapy ◽  
Diabetes Melitus

PREDICTORS OF SYMPTOMATIC INTRACEREBRAL HEMORRHAGE FOLLOWING INTRAVENOUS THROMBOLYSIS IN ACUTE ISCHEMIC STROKEABSTRACTDespite its effectiveness, the percentage of ischemic stroke patients who received definitive treatment, thrombolysis, never went above 10%, due to one of the reason is the occurrence of severe, post-therapeutic complications, such as symptomatic intracerebral hemorrhage (sICH). Several factors contribute to sICH occurrence are age, severity of stroke, early changes of ischemic sign, hyperglycemia, blood pressure, antiplatelet use and its interval. Patients with highest risk of sICH has been shown to have the greatest benefits from thrombolysis among other subgroup patients, therefore withholding therapy is not a choice. Compliance to the stroke’s guidelines could reduce the risk of complications as well as boost effectiveness of treatment.Keywords: Safety predictors, acute ischemic stroke, thrombolysis, sICH ABSTRAK Walau terbukti efektif, persentase pasien yang dapat dilakukan tindakan definitif stroke iskemik akut berupa trombolisis  tidak  pernah  mencapai  angka  10%,  salah  satunya  disebabkan  pertimbangan  terhadap  komplikasi  berat, seperti symptomatic intracerebral hemorrhage (sICH). Beberapa faktor yang berpengaruh terhadap kejadian sICH antara lain usia, derajat stroke, perubahan tanda iskemik dini, hiperglikemia dan diabetes melitus, tekanan darah, penggunaan antiplatelet, serta waktu pemberian. Pasien dengan risiko sICH tertinggi memiliki keuntungan terbesar dari trombolisis sehingga menunda tindakan bukanlah suatu opsi. Kepatuhan terhadap panduan tindakan dapat mengurangi angka kejadian komplikasi berat.Kata kunci: Prediktor keamanan, stroke iskemik akut, trombolisis, sICH

scholarly journals Stroke subtypes in southern Iran

2015 ◽  
Vol 4 (1) ◽  
pp. 47-49
Author(s):  
Rasool Safari ◽  
Afshin Borhanihaghighi ◽  
Seyed Taghi Heydari ◽  
Anahid Safari ◽  
Salvador Cruz-Flores
Keyword(s):  
Ischemic Stroke ◽  
Subarachnoid Hemorrhage ◽  
Intracerebral Hemorrhage ◽  
Single Center ◽  
Stroke Patients ◽  
Stroke Subtype ◽  
Younger Patients ◽  
Single Center Study ◽  
Length Of Hospitalization ◽  
Center Study

Objective: To investigate about frequency of different subtypes of stroke in south of IranMethods: This  is a retrospective, single-center study  conducted at Namazi Hospital, Shiraz, south of Iran. Age, sex, length of hospitalization and  mortality  of  stroke patients were recorded by reviewing hospital medical records.Results: 16 351 patients (53.6% male, 46.4%female) were recruited.  Ischemic stroke (10750 patients, 65.7%), intracerebral hemorrhage(3282 patients,20.1%) and subarachnoid hemorrhage(1057 patients,6.5%)  were the most common subtypes of stroke, respectively. In 1262 patients (7.7%) the stroke subtype could not been specified. Ischemic stroke and intracerebral hemorrhage were more common in men but subarachnoid hemorrhage was more common in women. Subarachnoid hemorrhage occurred significantly in younger patients. Mortality was significantly higher in intracerebral hemorrhage. Hospital stay was significantly longer in subarachnoid hemorrhage group.Conclusion: the distribution of the different  subtypes of stroke in Iran is similar to Caucasians.

scholarly journals Elevated Pulse Pressure and Recurrent Hemorrhagic Stroke Risk in Stroke With Cerebral Microbleeds or Intracerebral Hemorrhage

2021 ◽  
Author(s):  
Jong‐Ho Park ◽  
Juneyoung Lee ◽  
Sun U. Kwon ◽  
Hyuk Sung Kwon ◽  
Min Hwan Lee ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Cardiovascular Events ◽  
Operating Characteristic ◽  
Hemorrhagic Stroke ◽  
Stroke Risk ◽  
Characteristic Curve ◽  
Cerebral Microbleeds ◽  
Major Adverse Cardiovascular Events

Background Which type of recurrent stroke is associated with pulse pressure (PP) remains uncertain in ischemic stroke with cerebral microbleeds or intracerebral hemorrhage. Methods and Results The (PICASSO) Prevention of Cardiovascular Events in Ischemic Stroke Patients With High Risk of Cerebral Hemorrhage database involving 1454 subjects was analyzed. Subjects were stratified into quartiles according to the distribution of mean PP (mm Hg) during follow‐up (mean, 1.9 years): <47 (first quartile), 48 to 53 (second quartile), 54 to 59 (third quartile), and ≥60 mm Hg (fourth quartile). The primary end point was hemorrhagic stroke, and the secondary end points were ischemic stroke, stroke of any type, and major adverse cardiovascular events. Adjusted time‐dependent area under the receiver operating characteristic curve analysis was performed to assess the prediction accuracy of mean PP. The mean frequency of visit for blood pressure checkup was 9.4±5.5 times. The stroke incidence rate per 100 person‐years was 3.14, 2.24, 5.52, and 6.22, respectively in increasing quartile of mean PP, and the rate of major adverse cardiovascular events was 3.82, 2.84, 6.37, and 7.14, respectively. In the presence of mean arterial pressure, hemorrhagic stroke risk was higher in the highest quartile (adjusted hazard ratio, 6.03; 95% CI, 1.04–34.99) versus the lowest quartile, which was evident at higher mean systolic blood pressure. Higher mean PP as a continuous variable was also a predictor of hemorrhagic stroke (1.09, 1.03−1.15). The time‐dependent area under the receiver operating characteristic curve for hemorrhagic stroke was 0.79. Conclusions Long‐term elevated PP with higher systolic blood pressure confers a greater risk of subsequent hemorrhagic stroke among stroke patients with cerebral microbleeds or intracerebral hemorrhage. Registration URL: https://www.clinicaltrials.gov ; Unique identifier, NCT01013532.

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