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From Stanford Stroke Center (Drs. Kakuda, Lansberg, Bammer, Moseley, Marks, and Albers, and S. Kemp), Stanford University Medical Center, Palo Alto, CA; Department of Neurology (Dr. Thijs), University Hospitals of Leuven, Belgium; and Department of Neurology and Neurological Surgery (Dr. Wechsler), University of Pittsburgh Medical Center, PA.
Address correspondence and reprint requests to Dr. W. Kakuda, 701 Welch Road, Suite B 325, Palo Alto, CA 94304; e-mail: wkakuda{at}stanford.edu
Background: Cerebral microbleeds (MBs) detected on gradient echo (GRE) imaging may be a risk factor for hemorrhagic complications in patients with stroke treated with IV tissue plasminogen activator (tPA).
Methods: The authors prospectively evaluated patients with acute ischemic stroke treated with IV tPA between 3 and 6 hours of symptom onset. MRI scans, including GRE imaging, were performed prior to tPA treatment, 3 to 6 hours after treatment and at day 30. The authors compared the frequency of hemorrhagic complications after thrombolysis in patients with and without MBs on their baseline GRE imaging.
Results: Seventy consecutive patients (mean age, 71 ± 29 years; 31 men, 39 women) were included. MBs were identified in 11 patients (15.7%) on baseline GRE imaging. There was no significant difference in the frequency of either symptomatic or asymptomatic hemorrhagic complications after thrombolysis between patients with and without MBs at baseline. None of the 11 patients with MBs (0%) at baseline had a symptomatic intracerebral hemorrhage compared with 7 of 59 patients who did not have baseline MBs (11.9%). In addition, no patients with baseline MBs had asymptomatic hemorrhagic transformation observed at the site of any pre-treatment MB.
Conclusions: The presence of cerebral microbleeds on gradient echo imaging does not appear to substantially increase the risk of either symptomatic or asymptomatic brain hemorrhage following IV tissue plasminogen activator administered between 3 and 6 hours after stroke onset.
*The DEFUSE Investigators are listed in the Appendix.
The funding for this study was provided by NIH grants RO1 NS3 9325, Principal Investigator Gregory W. Albers, and K24 NS0 44848, Principal Investigator Gregory W. Albers.
Disclosure: The NIH funded this entire study, except for the tPA, which was provided by Genentech at no charge. Some of the authors have consulting relationships with Genentech, others have participated as investigators in prior trials sponsored by Genentech or have received honoraria for lectures sponsored by Genentech. None of the authors, or the members of the DEFUSE Investigator group, have any financial relationship with Genentech in excess of $10,000/year.
Received May 23, 2005. Accepted in final form July 13, 2005.
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