Marie-Yvonne Douste-Blazy

Centre Hospitalier Universitaire Sainte-Justine

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Peter M. Rothwell

University of Oxford

Timothy J. England

University of Nottingham

Mi Yang

Nanjing Drum Tower Hospital

Martin Dennis

University of Edinburgh

Vincent Thijs

Florey Institute of Neuroscience and Mental Health

Yvo B.W.E.M. Roos

Amsterdam University Medical Centers

Beatriz Gómez‐Ansón

Hospital de Sant Pau

Nick Ward

Aintree University Hospitals NHS Foundation Trust

Ender Uysal

Sağlık Bilimleri Üniversitesi

Maria Valdés Hernández

University of Edinburgh

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University College London

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Biomedical Research Institute

Hospital de Sant Pau

National Hospital for Neurology and Neurosurgery

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Chinese University of Hong Kong

University of Edinburgh

University of Hong Kong

Union Hospital

University Hospital of Bern

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Value of respiratory variations of right ventricular dimension in the identification of small atrial septal defects (secundum type) not requiring surgery: An echocardiographic study

American Heart Journal (1986)

Pierre Mauran Jean‐Claude Fouron Ana-Maria Carceller Marie-Yvonne Douste-Blazy Nicolaas H. Van Doesburg

Septum secundum

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Heart septal defect

10.1016/0002-8703(86)90520-x

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Cerebral microbleeds and stroke risk after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies

The Lancet Neurology (2019)

Duncan Wilson Gareth Ambler Keon‐Joo Lee Jae‐Sung Lim Masayuki Shiozawa

BackgroundCerebral 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.MethodsWe 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.FindingsBetween 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 [1·19–1·80] 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 [1·23–2·82]). 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).InterpretationIn 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.FundingBritish Heart Foundation and UK Stroke Association.

Stroke

Ischaemic stroke

10.1016/s1474-4422(19)30197-8

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Citations (169)