Intravenous thrombolysis in patients with acute ischemic stroke and cerebral microbleeds: Results from the ENCHANTED trial

作者：Zien Zhou, Yilun Ge, Sohei Yoshimura, Takako Torii-Yoshimura, Yuki Sakamoto, Xiaoqiu Liu, Cheryl Carcel, Xiaoying Chen, Leibo Liu, Mark Parsons, Grant Mair, Richard I. Lindley, Joanna M. Wardlaw, Craig S Anderson, Candice Delcourt · 发表于：International Journal of Stroke · 年份：2025 · DOI：10.1177/17474930251392751 · 被引用次数：3 · 研究领域：Intracerebral and Subarachnoid Hemorrhage Research、Acute Ischemic Stroke Management、Traumatic Brain Injury and Neurovascular Disturbances

Objective: To determine associations between cerebral microbleeds (CMBs) and intracerebral hemorrhage (ICH) as well as functional recovery after thrombolysis in participants of the Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED). Methods: ENCHANTED recruited acute ischemic stroke (AIS) patients eligible for thrombolytic therapy from 111 clinical centers in 13 countries. We included those with T2*-weighted or susceptibility-weighted brain magnetic resonance imaging within 6 h after AIS. Associations between CMB (primary predictor), burden (0, 1, 2–4, or ⩾5 CMBs), and location (deep, lobar, mixed) and any ICH (primary outcome), symptomatic intracerebral hemorrhage (sICH), 90-day disability or death (modified Rankin scale (mRS) score 2–6), and other unfavorable functional outcomes (mRS 3–6, 6, and shift) were explored in logistic regression models and in a stratification by alteplase dose. Results: Of 311 eligible AIS participants, 111 (35.7%) had CMB(s) and this was not associated with an increase in any ICH (adjusted odds ratio = 1.49, 95% confidence interval (CI) = 0.87–2.54) or sICH (2.05, 0.92–4.56). However, the presence of CMB(s) was associated with 90-day disability or death (1.75, 1.04–2.94) and other unfavorable functional outcomes. Comparable associations were seen between CMB burden (defined as ordinally categorical; any ICH 1.16 (0.90–1.50), mRS 2–6 1.44 (1.11–1.87)) or mixed deep-lobar distribution (any ICH 1.42 (0.61–3.29), mRS 2–6 3.66 ...