Microbleeds, Cerebral Hemorrhage, and Functional Outcome After Stroke Thrombolysis

I don't see anything here that is going to get patients 100% recovered. Problem description but no resolution. 

Microbleeds, Cerebral Hemorrhage, and Functional Outcome After Stroke Thrombolysis

Individual Patient Data Meta-Analysis

Andreas Charidimou, Guillaume Turc, Catherine Oppenheim, Shenqiang Yan, Jan F. Scheitz, Hebun Erdur, Pascal P. Klinger-Gratz, Marwan El-Koussy, Wakoh Takahashi, Yusuke Moriya, Duncan Wilson, Chelsea S. Kidwell, Jeffrey L. Saver, Asma Sallem, Solene Moulin, Myriam Edjlali-Goujon, Vincent Thijs, Zoe Fox, Ashkan Shoamanesh, Gregory W. Albers, Heinrich P. Mattle, Oscar R. Benavente, H. Rolf Jäger, Gareth Ambler, Junya Aoki, Jean-Claude Baron, Kazumi Kimura, Wataru Kakuda, Shunya Takizawa, Simon Jung, Christian H. Nolte, Min Lou, Charlotte Cordonnier, David J. Werring

https://doi.org/10.1161/STROKEAHA.116.012992

Stroke. 2017;48:2084-2090

Originally published July 18, 2017

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Abstract

Background and Purpose—We assessed whether the presence, number, and distribution of cerebral microbleeds (CMBs) on pre-intravenous thrombolysis MRI scans of acute ischemic stroke patients are associated with an increased risk of intracerebral hemorrhage (ICH) or poor functional outcome.

Methods—We performed an individual patient data meta-analysis, including prospective and retrospective studies of acute ischemic stroke treated with intravenous tissue-type plasminogen activator. Using multilevel mixed-effects logistic regression, we investigated associations of pre-treatment CMB presence, burden (1, 2–4, ≥5, and >10), and presumed pathogenesis (cerebral amyloid angiopathy defined as strictly lobar CMBs and noncerebral amyloid angiopathy) with symptomatic ICH, parenchymal hematoma (within [parenchymal hemorrhage, PH] and remote from the ischemic area [remote parenchymal hemorrhage, PHr]), and poor 3- to 6-month functional outcome (modified Rankin score >2).

Results—In 1973 patients from 8 centers, the crude prevalence of CMBs was 526 of 1973 (26.7%). A total of 77 of 1973 (3.9%) patients experienced symptomatic ICH, 210 of 1806 (11.6%) experienced PH, and 56 of 1720 (3.3%) experienced PHr. In adjusted analyses, patients with CMBs (compared with those without CMBs) had increased risk of PH (odds ratio: 1.50; 95% confidence interval: 1.09–2.07; P=0.013) and PHr (odds ratio: 3.04; 95% confidence interval: 1.73–5.35; P<0.001) but not symptomatic ICH. Both cerebral amyloid angiopathy and noncerebral amyloid angiopathy patterns of CMBs were associated with PH and PHr. Increasing CMB burden category was associated with the risk of symptomatic ICH (P=0.014), PH (P=0.013), and PHr (P<0.00001). Five or more and >10 CMBs independently predicted poor 3- to 6-month outcome (odds ratio: 1.85; 95% confidence interval: 1.10–3.12; P=0.020; and odds ratio: 3.99; 95% confidence interval: 1.55–10.22; P=0.004, respectively).

Conclusions—Increasing CMB burden is associated with increased risk of ICH (including PHr) and poor 3- to 6-month functional outcome after intravenous thrombolysis for acute ischemic stroke.