Tương quan giữa vi xuất huyết não và tỉ lệ chuyển dạng xuất huyết sau điều trị tái thông trong nhồi máu não cấp

Abstract

Objective: This study aimed to assess the safety and efficacy of reperfusion therapy in acute ischemic stroke patients with pre‑existing cerebral microbleeds (CMBs) identified on pretreatment magnetic resonance imaging (MRI). Subject and method: We conducted a retrospective–prospective descriptive cross‑sectional study at 115 People’s Hospital, including 357 consecutive patients treated between January 2021 and January 2025. Data on cerebral microbleeds detected on pretreatment MRI were retrieved from the PACS database. Associations between CMBs and clinical outcomes were analyzed using multivariable logistic regression. Outcomes of interest included symptomatic intracerebral hemorrhage (sICH), mortality, and favorable functional outcome (modified Rankin Scale [mRS] 0-2) at 90 days. Result: CMBs were identified in 19% of patients. Lobar CMBs were the most common, accounting for 57.4% of all lesions. Most patients (82%) had a CMB burden of 1-4 lesions. CMBs were associated with a statistically significant increase in the risk of any hemorrhagic transformation in the univariate analysis (odds ratio [OR] 2.13, 95% confidence interval 1.25-3.65, p=0.01). However, cerebral microbleeds were not an independent predictor of any hemorrhagic transformation in the multivariate analysis. The presence of CMBs was not significantly associated with sICH, 90‑day mortality, or favorable functional outcome at 90 days following reperfusion therapy. Conclusion: Cerebral microbleeds should not be considered a contraindication to reperfusion therapy in acute ischemic stroke, as they do not adversely influence treatment safety or clinical efficacy. Routine MRI screening for all acute ischemic stroke patients solely to detect CMBs prior to reperfusion therapy is unwarranted