Intracerebral Hemorrhage Risk Of Acute Ischemic Stroke Patients With Cerebral Microbleeds After Intravenous Thrombolysis A Meta-analysis

Objective:To evaluate cerebral microbleeds (CMBs) and post intravenous thrombolysis (IVT) intracerebral hemorrhage in patients with acute ischemic stroke (AIS).Methods:We screened 5 electronic databases to identify eligible studies from inception to October,2018.We used Mantel – Haenszel fixed-effects method to compute pooled odds ratio (OR) with 95% confidence intervals (CI) in Stata14.0.Results:We included studies that reported the relationship between CMBs and symptomatic intracerebral hemorrhage (s ICH) or hemorrhagic transformation (HT) after thrombolysis.Eight studies met inclusion criteria (total 2776 patients).The overall prevalence of CMBs on pre-IVT MRI scans was 23.88%.Pre-existing CMBs on magnetic resonance imaging (MRI) scans were significantly associated with a higher risk of early s ICH (OR 2.58;95% CI 1.63-4.10;P=0.000) and HT (OR 1.50;95% CI 1.12-2.01;P=0.007).Subgroup analyses substantially influence these associations.A higher risk for s ICH after IVT was detected in patients with high CMB burden (>10CMBs) when compared with patients with 1 to 10 CMBs (OR 2.74;95% CI 1.67-4.48;P=0.000).Conclusion:CMBs presence was significantly associated with the increased risk of early s ICH and HT after intravenous thrombolysis.Presence of CMB and high CMB burdens on pretreatment MRI were independently and closely associated with s ICH in patients with AIS treated with IVT.