Benefit of Intravenous Thrombolysis in Acute Ischemic Stroke Patients With High Cerebral Microbleed Burden
| Autor: | David J. Werring, Christian H. Nolte, Matthias Endres, Ludwig Schlemm |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Brain Ischemia Modified Rankin Scale Internal medicine diagnostic imaging [Stroke] medicine Humans Thrombolytic Therapy Treatment effect ddc:610 Acute ischemic stroke Cerebral Hemorrhage Advanced and Specialized Nursing Intracerebral hemorrhage drug therapy [Cerebral Hemorrhage] medicine.diagnostic_test business.industry Models Cardiovascular Magnetic resonance imaging Odds ratio Thrombolysis diagnostic imaging [Cerebral Hemorrhage] medicine.disease Magnetic Resonance Imaging drug therapy [Stroke] Stroke Pre- and post-test probability diagnostic imaging [Brain Ischemia] Acute Disease Cardiology drug therapy [Brain Ischemia] Administration Intravenous Female Neurology (clinical) Cardiology and Cardiovascular Medicine business |
| Zdroj: | Stroke 51(1), 232-239 (2020). doi:10.1161/STROKEAHA.119.027633 |
| ISSN: | 1524-4628 0039-2499 |
| DOI: | 10.1161/strokeaha.119.027633 |
| Popis: | Background and Purpose— Cerebral microbleeds (CMBs) are a risk factor for intracranial hemorrhage. Whether intravenous thrombolysis (IVT) improves functional outcome in acute ischemic stroke patients with CMBs is unknown. We aimed to estimate the treatment effect of IVT in patients with acute ischemic stroke and a high burden (>10) of CMBs. Methods— We devised a multistep algorithm to model 90-day modified Rankin Scale scores in patients with ≤10 versus >10 CMBs who do or do not receive IVT. Parameters were extracted from recently published meta-analyses and included pairwise relationships between CMBs, IVT, 3-month functional outcome, and intracranial hemorrhage. Uncertainty was quantified in probabilistic sensitivity analyses. Results— In patients with >10 CMBs as compared with ≤10 CMBs, point estimates of the odds ratios for favorable outcome (modified Rankin Scale ≤2) associated with IVT were 7% to 10% lower but still >1 (range, 1.03–1.51). On the other hand, IVT in patients with >10 CMBs significantly increased the odds of mortality. The point estimates for the net treatment effect of IVT (change in the utility-weighted modified Rankin Scale score) in patients with >10 CMBs were in favor of withholding IVT in older patients with more severe strokes and longer treatment delays. However, because the general pretest probability of >10 CMBs is low (0.6%–2.7%), pretreatment magnetic resonance imaging to quantify CMB burden would be justified only if it delayed IVT by Conclusions— High CMB burden modifies the treatment effect of IVT. In patients with >10 CMBs, IVT is associated with higher mortality and, in older patients with severe strokes and longer treatment delays, a net utility loss. Patients with higher-than-average pretest probability of >10 CMB might profit from magnetic resonance imaging screening if it does not increase the treatment time. |
| Databáze: | OpenAIRE |
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