EXPRESS: Cerebral microbleeds development after stroke thrombolysis: A secondary analysis of the THAWS randomized clinical trial

 You described a problem of cerebral microbleeds but gave us nothing on how to prevent them or treat them after they've occurred. Useless.

EXPRESS: Cerebral microbleeds development after stroke thrombolysis: A secondary analysis of the THAWS randomized clinical trial

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Kaori Miwa, Masatoshi Koga, Manabu Inoue, , , , , , , , , , , , , , , , ...

First Published July 20, 2021 Research Article 

https://doi.org/10.1177/17474930211035023

Article information

Abstract

Background and aim: 

 We determined to investigate the incidence and clinical impact of new cerebral microbleeds (CMBs) after intravenous thrombolysis (IVT) in patients with acute stroke.

Methods: 

The THAWS was a multicenter, randomized trial to study the efficacy and safety of IVT with alteplase in patients with wake-up stroke or unknown onset stroke. Prescheduled T2*-weighted imaging assessed CMBs at 3-time points: baseline, 22–36 hours, and 7–14 days. Outcomes included new CMBs development, modified Rankin Scale [mRS] ≥3 at 90 days, and change in the National Institutes of Health Stroke Scale [NIHSS] score from 24 h to 7 days.

Results:  

Of all 131 patients randomized in the THAWS trial, 113 patients (mean 74.3±12.6 years, 50 female, 62 allocated to IVT) were available for analysis. Overall, 46 (41%) had baseline CMBs (15 strictly lobar CMBs, 14 mixed CMBs, and 17 deep CMBs). New CMBs only emerged in the IVT group (7 patients, 11%) within a median of 28.3 h, and did not additionally increase within a median of 7.35 days. In adjusted models, number of CMBs (relative risk [RR]1.30, 95%confidence interval [CI]: 1.17–1.44), mixed distribution (RR 19.2, 95%CI: 3.94–93.7), and CMBs burden ≥5 (RR 44.9, 95%CI: 5.78–349.8) were associated with new CMBs. New CMBs was associated with an increase in NIHSS score (p=0.023). Treatment with alteplase in patients with baseline ≥5 CMBs resulted in a numerical shift toward worse outcomes on ordinal mRS (median [IQR]; 4 [3–4] vs. 0 [0–3]), compared with those with <5 CMBs (common odds ratio 17.1, 95% CI: 0.76 –382.8). The association of baseline ≥5 CMBs with ordinal mRS score differed according to the treatment group (P interaction=0.042).

Conclusion: 

New CMBs developed within 36 h in 11% of the patients after IVT, and they were significantly associated with mixed-distribution and ≥5 CMBs. New CMBs development might impede neurological improvement. Furthermore, CMBs burden might affect the effect of alteplase.

Keywords

Brain microbleeds, Intracerebral hemorrahage, Ischaemic stroke, Stroke, Thrombolysis, rtPA

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