Cerebral microbleeds and stroke risk after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies
- 주제(기타) Clinical Neurology
- 설명문(일반) [Seiffge, David J.; Williams, David J.; Barbato, Carmen; Browning, Simone; Simister, Robert; Werring, David J.] UCL Queen Sq Inst Neurol, Stroke Res Ctr, Dept Brain Repair & Rehabil, London WC1B 5EH, England; [Wilson, Duncan; Seiffge, David J.; Barbato, Carmen; Browning, Simone; Simister, Robert] Natl Hosp Neurol & Neurosurg, London, England; [Wilson, Duncan] New Zealand Brain Res Inst, Christchurch, New Zealand; [Ambler, Gareth] UCL, Dept Stat Sci, London, England; [Lee, Keon-Joo; Bae, Hee-Joon] Seoul Natl Univ, Bundang Hosp, Dept Neurol, Sch Med, Seongnam, South Korea; [Lim, Jae-Sung] Hallym Univ, Sacred Heart Hosp, Dept Neurol, Anyang, South Korea; [Shiozawa, Masayuki; Koga, Masatoshi; Toyoda, Kazunori] Natl Cerebral & Cardiovasc Ctr, Dept Cerebrovasc Med, Suita, Osaka, Japan; [Li, Linxin] Univ Oxford, Str Prevent Stroke & Dementia, Oxford, England; [Lovelock, Caroline; Chabriat, Hugues] Lariboisiere Hosp, AP HP, Dept Neurol, Paris, France; [Chabriat, Hugues; Jouvent, Eric] Univ Paris Diderot, Dept Hosp Univ NeuroVasc, Paris, France; [Chabriat, Hugues; Jouvent, Eric] INSERM U1141, Paris, France; [Hennerici, Michael] Univ Mannheim, Univ Heidelberg, Dept Neurol, Mannheim, Germany; [Wong, Yuen Kwun; Lau, Kui Kai] Univ Hong Kong, Div Neurol, Dept Med, Hong Kong, Peoples R China; [Mak, Henry Ka Fung] Univ Hong Kong, Dept Diagnost Radiol, Hong Kong, Peoples R China; [Prats-Sanchez, Luis; Martinez-Domeno, Alejandro; Marti-Fabregas, Joan] Hosp Santa Creu & Sant Pau, Dept Neurol, Biomed Res Inst, Barcelona, Spain; [Inamura, Shigeru; Yoshifuji, Kazuhisa; Imaizumi, Toshio] Kushiro City Gen Hosp, Dept Neurosurg, Kushiro, Japan; [Arsava, Ethem Murat; Ay, Hakan] Harvard Med Sch, Dept Neurol, Massachusetts Gen Hosp, Boston, MA 02115 USA; [Arsava, Ethem Murat; Ay, Hakan] Harvard Med Sch, Dept Radiol, Massachusetts Gen Hosp, Boston, MA 02115 USA; [Horstmann, Solveig; Purrucker, Jan] Univ Heidelberg Hosp, Dept Neurol, Heidelberg, Germany; [Lam, Bonnie Yin Ka; Wong, Adrian; Mok, Vincent] Chinese Univ Hong Kong, Dept Med & Therapeut, Gerald Choa Neurosci Ctr, Lui Che Woo Inst Innovat Med,Therese Pei Fong Cho, Hong Kong, Peoples R China; [Kim, Young Dae; Heo, Ji Hoe] Yonsei Univ, Coll Med, Dept Neurol, Seoul, South Korea; [Song, Tae-Jin] Ewha Womans Univ, Coll Med, Dept Neurol, Seoul, South Korea; [Schrooten, Maarten] VIB, Ctr Brain & Dis Res, Leuven, Belgium; [Lemmens, Robin] Katholieke Univ Leuven, Univ Leuven, Lab Neurobiol, Leuven, Belgium; [Eppinger, Sebastian; Gattringer, Thomas; Fazekas, Franz] Med Univ Graz, Dept Neurol, Graz, Austria; [Uysal, Ender; Tanriverdi, Zeynep; Orken, Dilek Necioglu] Demiroglu Bilim Univ, Dept Neurol, Istanbul, Turkey; [Bornstein, Natan M.; Ben Assayag, Einor; Hallevi, Hen] Tel Aviv Sourasky Med Ctr, Dept Neurol, Tel Aviv, Israel; [Bornstein, Natan M.; Ben Assayag, Einor; Hallevi, Hen] Tel Aviv Univ, Sackler Fac Med, Tel Aviv, Israel; [Tanaka, Jun; Hara, Hideo; Yakushiji, Yusuke] Saga Univ, Fac Med, Div Neurol, Dept Internal Med, Saga, Japan; [Coutts, Shelagh B.; Smith, Eric E.] Univ Calgary, Hotchkiss Brain Inst, Dept Clin Neurosci Radiol & Community Hlth Sci, Calgary Stroke Program, Calgary, AB, Canada; [Hert, Lisa; Polymeris, Alexandros; Seiffge, David J.; Lyrer, Philippe; Engelter, Stefan T.; Peters, Nils] Univ Basel Hosp, Dept Neurol, Basel, Switzerland; [Hert, Lisa; Polymeris, Alexandros; Seiffge, David J.; Lyrer, Philippe; Engelter, Stefan T.; Peters, Nils] Univ Basel Hosp, Stroke Ctr, Basel, Switzerland; [Hert, Lisa; Polymeris, Alexandros; Seiffge, David J.; Lyrer, Philippe; Engelter, Stefan T.; Peters, Nils] Univ Basel, Basel, Switzerland; [Algra, Ale] Univ Med Ctr Utrecht, Julius Ctr Hlth Sci & Primary Care, Utrecht, Netherlands; [Algra, Ale; Kappelle, Jaap] Univ Med Ctr Utrecht, Dept Neurol & Neurosurg, Utrecht Stroke Ctr, Utrecht, Netherlands; [Algra, Ale; Kappelle, Jaap] Univ Utrecht, Utrecht, Netherlands; [Salman, Rustam Al-Shahi] Univ Edinburgh, Ctr Clin Brain Sci, Edinburgh, Midlothian, Scotland; [Chappell, Francesca] Univ Edinburgh, Edinburgh Imaging, Edinburgh, Midlothian, Scotland; [Chappell, Francesca; Wardlaw, Joanna M.] Univ Edinburgh, Sch Clin Sci, Edinburgh, Midlothian, Scotland; [Jager, Hans R.] UCL Inst Neurol, Dept Brain Repair & Rehabil, Lysholm Dept Neuroradiol, London, England; [Jager, Hans R.] UCL Inst Neurol, Neuroradiol Acad Unit, London, England; [Jager, Hans R.] Natl Hosp Neurol & Neurosurg, London, England; [Lip, Gregory Y. H.] Univ Liverpool, Cardiovasc Sci, Liverpool Heart & Chest Hosp, Liverpool, Merseyside, England; [Lip, Gregory Y. H.] Aalborg Univ, Aalborg Thrombosis Res Unit, Dept Clin Med, Aalborg, Denmark; [Seiffge, David J.; Mattle, Heinrich P.; Panos, Leonidas D.; Jung, Simon] Univ Bern, Univ Hosp Bern, Dept Diagnost & Intervent Neuroradiol, Bern, Switzerland; [Seiffge, David J.; Mattle, Heinrich P.; Panos, Leonidas D.; Jung, Simon] Univ Bern, Univ Hosp Bern, Dept Neurol, Inselspital, Bern, Switzerland; [Mas, Jean-Louis] Paris Descartes Univ, INSERM U1266, St Anne Hosp, Dept Neurol, Paris, France; [Legrand, Laurence] Paris Descartes Univ, INSERM U1266, St Anne Hosp, Dept Neuroradiol, Paris, France; [Karayiannis, Christopher; Srikanth, Velandai] Peninsula Hlth, Peninsula Clin Sch, Melbourne, Vic, Australia; [Phan, Thanh] Monash Univ, Stroke & Ageing Res Grp, Sch Clin Sci, Monash Hlth, Melbourne, Vic, Australia; [Gunkel, Sarah; Christ, Nicolas; Fluri, Felix] Univ Hosp Wurzburg, Dept Neurol, Josef Schneider Str 11, Wurzburg, Germany; [Abrigo, Jill; Chu, Winnie] Chinese Univ Hong Kong, Dept Imaging & Intervent Radiol, Prince Wales Hosp, Hong Kong, Peoples R China; [Abrigo, Jill; Leung, Thomas; Chu, Winnie; Soo, Yannie] Chinese Univ Hong Kong, Dept Med & Therapeut, Prince Wales Hosp, Hong Kong, Peoples R China; [Makin, Stephen] Univ Glasgow, Inst Cardiovasc & Med Sci, Glasgow, Lanark, Scotland; [Hayden, Derek; Kelly, Peter J.] Univ Coll Dublin, Neurovasc Res Unit & Hlth Res Board, Stroke Clin Trials Network Ireland, Dublin, Ireland; [Williams, David J.] Royal Coll Surgeons Ireland, Dept Geriatr & Stroke Med, Dublin, Ireland; [Williams, David J.] Beaumont Hosp, Dublin, Ireland; [Kooi, M. Eline] Maastricht Univ, Med Ctr, Dept Radiol & Nucl Med, Maastricht, Netherlands; [Kooi, M. Eline; van Oostenbrugge, Robert; Staals, Julie] Maastricht Univ, Med Ctr, Dept Neurol, CARIM Sch Cardiovasc Dis, Maastricht, Netherlands; [Barbato, Carmen; Browning, Simone; Simister, Robert] Univ Coll London Hosp NHS Trust, Comprehens Stroke Serv, London, England; [Wiegertjes, Kim; Tuladhar, Anil M.; de Leeuw, Frank-Erik] Radboud Univ Nijmegen, Donders Ctr Med Neurosci, Med Ctr, Dept Neurol,Donders Inst Brain Cognit & Behav,Don, Nijmegen, Netherlands; [Maaijwee, Noortje] Lucerne State Hosp, Luzern, Switzerland; [Maaijwee, Noortje] Ctr Neurol & Neurorehabil, Luzern, Switzerland; [Guevarra, Christine; Yatawara, Chathuri; Kandiah, Nagaendran] Natl Neurosci Inst, Dept Neurol, Singapore, Singapore; [Mendyk, Anne-Marie; Delmaire, Christine; Bordet, Regis] Univ Lille, INSERM, CHU Lille, Degenerat & Vasc Cognit Disorders U1171, Lille, France; [Kohler, Sebastian] Maastricht Univ, Dept Psychiat & Neuropsychol, Sch Mental Hlth & Neurosci, Maastricht, Netherlands; [Zhou, Ying; Xu, Chao; Lou, Min] Zhejiang Univ, Sch Med, Affiliated Hosp 2, Dept Neurol, Hangzhou, Zhejiang, Peoples R China; [Hilal, Saima; Gyanwali, Bibek; Chen, Christopher] Natl Univ Hlth Syst, Memory Aging & Cognit Ctr, Singapore, Singapore; [Kwa, Vincent I. H.] Onze Lieve Vrouw Hosp, Dept Neurol, Amsterdam, Netherlands; [Engelter, Stefan T.; Peters, Nils] Univ Basel, Univ Dept Geriatr Med Felix Platter, Neurol & Neurorehabil, Basel, Switzerland; [Thijs, Vincent] Univ Melbourne, Florey Inst Neurosci & Mental Hlth, Stroke Div, Melbourne, Vic, Australia; [Thijs, Vincent] Austin Hlth, Dept Neurol, Melbourne, Vic, Australia; [Thijs, Vincent] Univ Hosp Leuven, Dept Neurosci, Leuven, Belgium; [Veltkamp, Roland] Imperial Coll London, Dept Stroke Med, London, England; [Veltkamp, Roland] Univ Heidelberg Hosp, Dept Neurol, Heidelberg, Germany; [Gomez-Anson, Beatriz] Univ Autonoma Barcelona, Unit Neuroradiol, Hosp Santa Creu & St Pau, Barcelona, Spain; [van Dam-Nolen, Dianne H. K.; van der Lugt, Aad] Univ Med Ctr, Erasmus Med Ctr, Dept Radiol & Nucl Med, Rotterdam, Netherlands
- 등재 SCIE, SCOPUS
- OA유형 Green Published, hybrid, Green Accepted
- 발행기관 ELSEVIER SCIENCE INC
- 발행년도 2019
- URI http://www.dcollection.net/handler/ewha/000000160481
- 본문언어 영어
- Published As http://dx.doi.org/10.1016/S1474-4422(19)30197-8
- PubMed https://pubmed.ncbi.nlm.nih.gov/31130428
초록/요약
Background Cerebral microbleeds are a neuroimaging biomarker of stroke risk. A crucial clinical question is whether cerebral microbleeds indicate patients with recent ischaemic stroke or transient ischaemic attack in whom the rate of future intracranial haemorrhage is likely to exceed that of recurrent ischaemic stroke when treated with antithrombotic drugs. We therefore aimed to establish whether a large burden of cerebral microbleeds or particular anatomical patterns of cerebral microbleeds can identify ischaemic stroke or transient ischaemic attack patients at higher absolute risk of intracranial haemorrhage than ischaemic stroke. Methods We did a pooled analysis of individual patient data from cohort studies in adults with recent ischaemic stroke or transient ischaemic attack. Cohorts were eligible for inclusion if they prospectively recruited adult participants with ischaemic stroke or transient ischaemic attack; included at least 50 participants; collected data on stroke events over at least 3 months follow-up; used an appropriate MRI sequence that is sensitive to magnetic susceptibility; and documented the number and anatomical distribution of cerebral microbleeds reliably using consensus criteria and validated scales. Our prespecified primary outcomes were a composite of any symptomatic intracranial haemorrhage or ischaemic stroke, symptomatic intracranial haemorrhage, and symptomatic ischaemic stroke. We registered this study with the PROSPERO international prospective register of systematic reviews, number CRD42016036602. Findings Between Jan 1, 1996, and Dec 1, 2018, we identified 344 studies. After exclusions for ineligibility or declined requests for inclusion, 20 322 patients from 38 cohorts (over 35 225 patient-years of follow-up; median 1.34 years [IQR 0-19-2.44]) were included in our analyses. The adjusted hazard ratio [aHR] comparing patients with cerebral microbleeds to those without was 1.35 (95% CI 1- 20-1- 50) for the composite outcome of intracranial haemorrhage and ischaemic stroke; 2.45 (1.82 3.29) for intracranial haemorrhage and 1. 23 (1.08 1.40) for ischaemic stroke. The aHR increased with increasing cerebral microbleed burden for intracranial haemorrhage but this effect was less marked for ischaemic stroke (for five or more cerebral microbleeds, aHR 4.55 [95% CI 3.08-6.72] for intracranial haemorrhage vs 1.47 [149-1.80] for ischaemic stroke; for ten or more cerebral microbleeds, aHR 5.52 [3.36-9.05] vs 1.43 [1.07 1.91]; and for >= 20 cerebral microbleeds, aHR 8.61 [4.69 15.81] vs 1.86 [1.23 1.82]). However, irrespective of cerebral microbleed anatomical distribution or burden, the rate of ischaemic stroke exceeded that of intracranial haemorrhage (for ten or more cerebral microbleeds, 64 ischaemic strokes [95% CI 48-84] per 1000 patient-years vs 27 intracranial haemorrhages [17-41] per 1000 patient-years; and for >= 20 cerebral microbleeds, 73 ischaemic strokes [46-108] per 1000 patient-years vs 39 intracranial haemorrhages [21-67] per 1000 patient-years). Interpretation In patients with recent ischaemic stroke or transient ischaemic attack, cerebral microbleeds are associated with a greater relative hazard (aHR) for subsequent intracranial haemorrhage than for ischaemic stroke, but the absolute risk of ischaemic stroke is higher than that of intracranial haemorrhage, regardless of cerebral microbleed presence, antomical distribution, or burden. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd.
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