Original Article
Contribution of Deep Microbleeds to Stroke Recurrence: Differences between Patients with Past Deep Intracerebral Hemorrhages and Lacunar Infarctions

https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.04.027Get rights and content

Background

This study investigated the contribution of deep cerebral microbleeds (MBs) to stroke recurrences in patients with histories of deep intracerebral hemorrhages (ICHs) or lacunar infarctions (LIs).

Methods

We prospectively analyzed stroke recurrences in patients admitted to our hospital who were treated for deep ICHs or LIs between April 2004 and December 2011. The number of deep MBs was counted on admission. Stroke recurrence–free rate curves were generated with the Kaplan–Meier method using the log-rank test. The odds ratios (ORs) for recurrent strokes were derived using multivariate logistic regression models, based on deep MBs and risk factors.

Results

We evaluated magnetic resonance images or the recurrences of 231 deep-ICH patients (92 women, 68.0 ± 12.0 years old) and 309 LI patients (140 women, 70.7 ± 11.7 years old). The incidences of deep ICHs (1.5%/year) and LIs (2.1%/year) presenting as stroke recurrences were significantly larger in LI patients with deep MBs than in those without (.01 [P = .0001] and .08%/year [P = .005], respectively). However, there was no significant difference between deep-ICH patients with and without MBs in terms of incidence of recurrences. Multivariate analyses revealed that deep MBs independently and significantly elevated the rate of deep ICHs (OR, 19.0; P = .007) or LIs (OR, 3.62; P = .008) presenting as recurrences in LI patients, but not in deep-ICH patients, when adjusted for stroke risk factors.

Conclusions

There may be differences between patients with deep ICHs and those with LIs in terms of the contribution of deep MBs to stroke recurrence.

Section snippets

Subjects

From April 2004 to December 2011, we enrolled patients consecutively admitted to our hospital within 7 days of experiencing deep ICHs or LIs (index strokes). Follow-up took place until March 2014 at the latest, and stroke recurrences were evaluated in all patients. We excluded patients with follow-up durations of less than 1 week, and those with unclear findings on MRIs due to motion or metal artifacts. All study procedures were approved by the Ethics Committee of Kushiro City General Hospital

Patients with Lacunar Infarctions as Index Strokes (LI Patients)

We consecutively enrolled 337 LI patients during the study period. Twenty-eight patients were excluded, including 6 with pacemakers, 7 who died within 7 days after the index stroke onset, 5 with unclear findings on MRIs, and 10 with insufficient records. Thus, 309 of the initial 337 LI patients were followed and stroke recurrences were investigated. The 309 patients were divided into 2 groups, those with deep MBs and those without. Table 1 presents stroke-related variables in the 2 groups.

Discussion

In this study, we examined the differences between patients with histories of deep ICHs and LIs in terms of the contribution of preexisting deep MBs to stroke recurrence.

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    The authors declare that they have no financial conflicts of interest and they did not receive any grants.

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