Cerebral Microbleeds Raise Risk of Thrombolysis Therapy in Acute Ischemic Stroke

MedicalResearch.com Interview with:
Dr. Georgios Tsivgoulis MD
Department of Neurology, The University of Tennessee Health Science Center, Memphis
Second Department of Neurology, Attikon Hospital, School of Medicine, University of Athens, Athens, Greece

Medical Research: What is the background for this study?

Dr. Tsivgoulis: Cerebral microbleeds (CMBs) have been established as an independent predictor of cerebral bleeding, but there are contradictory data regarding the potential association of CMB burden with the risk of symptomatic intracerebral hemorrhage (sICH) in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT).

Medical Research:  What are the main findings?

Dr. Tsivgoulis: We analyzed data from 9 prospective cohort studies, comprising 2479 total AIS patients, to investigate the association of high cerebral microbleed burden (>10 CMBs on pre-IVT MRI-scan) with the risk of sICH following IVT for AIS from. The risk of sICH after IVT was found to be higher in patients with evidence of CMB presence, compared to patients without CMBs, while a higher risk for sICHafter IVT was also detected in patients with high CMB burden (>10 CMBs), when compared to patients with 0-10 or 1-10 CMBs on pre-treatment MRI. In the individual patient data meta-analysis, high CMB burden was associated with increased likelihood of sICH before and after adjusting for potential confounders.

Medical Research: What should clinicians and patients take away from your report?

Dr. Tsivgoulis: Our findings suggest that CMB burden is an independent risk factor that may augment the risk of symptomatic intracerebral hemorrhage in  acute ischemic stroke patients treated exclusively with systemic thrombolysis.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Tsivgoulis: Cerebral microbleed burden may be included in individual risk stratification predicting the risk of sICH following IVT for AIS. The challenge remains how to identify CMB burden without MRI in the setting of AIS management where only a non-contrast CT is standard of care.


Tsivgoulis G, Zand R, Katsanos AH, et al. Risk of Symptomatic Intracerebral Hemorrhage After Intravenous Thrombolysis in Patients With Acute Ischemic Stroke and High Cerebral Microbleed Burden: A Meta-analysis. JAMA Neurol. Published online April 18, 2016. doi:10.1001/jamaneurol.2016.0292.

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Last Updated on April 20, 2016 by Marie Benz MD FAAD