Magnetic resonance imaging detection of microbleeds before thrombolysis: An emerging application

Stella Kidwell, Jeffrey L. Saver, J. Pablo Villablanca, Gary Duckwiler, Andre Fredieu, Kristi Gough, Megan C. Leary, Sidney Starkman, Y. Pierre Gobin, Reza Jahan, Paul Vespa, David S. Liebeskind, Jeffry R. Alger, Fernando Vinuela

Research output: Contribution to journalArticle

275 Citations (Scopus)

Abstract

Background - Hemorrhagic transformation (HT) is a major complication of thrombolytic treatment for acute ischemic stroke. Although a history of prior intracerebral hemorrhage diagnosed by head CT is a contraindication to thrombolysis, there are no guidelines or data regarding evidence of prior asymptomatic microbleeds visualized with T2*-weighted magnetic resonance imaging (MRI). Methods - Pretreatment T2*-weighted MRI sequences were retrospectively analyzed in all patients receiving intra-arterial thrombolytic therapy and undergoing a pretreatment MRI at our institution. The frequency and location of prior microbleeds was determined and compared with the frequency and location of secondary HT after therapy. Results - Five of 41 patients undergoing MRI before receiving intra-arterial thrombolytic therapy demonstrated evidence of prior microbleeds on the pretreatment MRI studies. Major symptomatic hemorrhage occurred in 1 of 5 patients with microbleeds compared with 4 of 36 patients without. Only 1 patient in the entire 41-patient cohort experienced any HT outside the acute ischemic field. In this patient, the symptomatic hemorrhage occurred directly at the site of a prior microbleed, contralateral to the acute ischemic event. Conclusions - Old silent microbleeds, visualized with T2*-weighted MRI sequences, may be a marker of increased risk of HT in patients receiving thrombolytic therapy for acute ischemic stroke. Pretreatment screening of thrombolytic candidates with these MRI sequences may be useful in the future to identify these patients.

Original languageEnglish (US)
Pages (from-to)95-98
Number of pages4
JournalStroke
Volume33
Issue number1
DOIs
StatePublished - 2002
Externally publishedYes

Fingerprint

Magnetic Resonance Imaging
Thrombolytic Therapy
Stroke
Hemorrhage
Cerebral Hemorrhage
Head
Guidelines
Therapeutics

Keywords

  • Hemorrhage
  • Magnetic resonance imaging
  • Stroke, acute
  • Stroke, ischemic
  • Thrombolysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

Cite this

Kidwell, S., Saver, J. L., Villablanca, J. P., Duckwiler, G., Fredieu, A., Gough, K., ... Vinuela, F. (2002). Magnetic resonance imaging detection of microbleeds before thrombolysis: An emerging application. Stroke, 33(1), 95-98. https://doi.org/10.1161/hs0102.101792

Magnetic resonance imaging detection of microbleeds before thrombolysis : An emerging application. / Kidwell, Stella; Saver, Jeffrey L.; Villablanca, J. Pablo; Duckwiler, Gary; Fredieu, Andre; Gough, Kristi; Leary, Megan C.; Starkman, Sidney; Gobin, Y. Pierre; Jahan, Reza; Vespa, Paul; Liebeskind, David S.; Alger, Jeffry R.; Vinuela, Fernando.

In: Stroke, Vol. 33, No. 1, 2002, p. 95-98.

Research output: Contribution to journalArticle

Kidwell, S, Saver, JL, Villablanca, JP, Duckwiler, G, Fredieu, A, Gough, K, Leary, MC, Starkman, S, Gobin, YP, Jahan, R, Vespa, P, Liebeskind, DS, Alger, JR & Vinuela, F 2002, 'Magnetic resonance imaging detection of microbleeds before thrombolysis: An emerging application', Stroke, vol. 33, no. 1, pp. 95-98. https://doi.org/10.1161/hs0102.101792
Kidwell, Stella ; Saver, Jeffrey L. ; Villablanca, J. Pablo ; Duckwiler, Gary ; Fredieu, Andre ; Gough, Kristi ; Leary, Megan C. ; Starkman, Sidney ; Gobin, Y. Pierre ; Jahan, Reza ; Vespa, Paul ; Liebeskind, David S. ; Alger, Jeffry R. ; Vinuela, Fernando. / Magnetic resonance imaging detection of microbleeds before thrombolysis : An emerging application. In: Stroke. 2002 ; Vol. 33, No. 1. pp. 95-98.
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AU - Kidwell, Stella

AU - Saver, Jeffrey L.

AU - Villablanca, J. Pablo

AU - Duckwiler, Gary

AU - Fredieu, Andre

AU - Gough, Kristi

AU - Leary, Megan C.

AU - Starkman, Sidney

AU - Gobin, Y. Pierre

AU - Jahan, Reza

AU - Vespa, Paul

AU - Liebeskind, David S.

AU - Alger, Jeffry R.

AU - Vinuela, Fernando

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AB - Background - Hemorrhagic transformation (HT) is a major complication of thrombolytic treatment for acute ischemic stroke. Although a history of prior intracerebral hemorrhage diagnosed by head CT is a contraindication to thrombolysis, there are no guidelines or data regarding evidence of prior asymptomatic microbleeds visualized with T2*-weighted magnetic resonance imaging (MRI). Methods - Pretreatment T2*-weighted MRI sequences were retrospectively analyzed in all patients receiving intra-arterial thrombolytic therapy and undergoing a pretreatment MRI at our institution. The frequency and location of prior microbleeds was determined and compared with the frequency and location of secondary HT after therapy. Results - Five of 41 patients undergoing MRI before receiving intra-arterial thrombolytic therapy demonstrated evidence of prior microbleeds on the pretreatment MRI studies. Major symptomatic hemorrhage occurred in 1 of 5 patients with microbleeds compared with 4 of 36 patients without. Only 1 patient in the entire 41-patient cohort experienced any HT outside the acute ischemic field. In this patient, the symptomatic hemorrhage occurred directly at the site of a prior microbleed, contralateral to the acute ischemic event. Conclusions - Old silent microbleeds, visualized with T2*-weighted MRI sequences, may be a marker of increased risk of HT in patients receiving thrombolytic therapy for acute ischemic stroke. Pretreatment screening of thrombolytic candidates with these MRI sequences may be useful in the future to identify these patients.

KW - Hemorrhage

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