Meta-Analysis

. 2016 Oct 4;87(14):1501-1510.

doi: 10.1212/WNL.0000000000003183. Epub 2016 Sep 2.

Recurrent stroke risk and cerebral microbleed burden in ischemic stroke and TIA: A meta-analysis

Duncan Wilson¹, Andreas Charidimou¹, Gareth Ambler¹, Zoe V Fox¹, Simone Gregoire¹, Phillip Rayson¹, Toshio Imaizumi¹, Felix Fluri¹, Hiromitsu Naka¹, Solveig Horstmann¹, Roland Veltkamp¹, Peter M Rothwell¹, Vincent I H Kwa¹, Vincent Thijs¹, Yong-Seok Lee¹, Young Dae Kim¹, Yining Huang¹, Ka Sing Wong¹, Hans Rolf Jäger¹, David J Werring²

Affiliations

¹ From the Stroke Research Centre (D.W., A.C., S.G., P.R., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery; Department of Statistical Science (G.A.) and Biomedical Research Centre (Z.V.F.), UCL, London, UK; Department of Neurosurgery (T.I.), Kushiro City General Hospital, Hokkaido, Japan; Department of Neurology (F.F.), University Hospital Würzburg, Germany; Department of Neurology (H.N.), Suiseikai Kajikawa Hospital, Hiroshima, Japan; Department of Neurology (S.H.), University of Heidelberg, Germany; Department of Stroke Medicine (R.V.), Division of Brain Sciences, Imperial College London; Nuffield Department of Clinical Neurosciences (P.M.R.), John Radcliffe Hospital, University of Oxford, UK; Department of Neurology (V.I.H.K.), Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands; Department of Neurology (V.T.), Austin Health and Melbourne Brain Center, University of Melbourne, Australia; Department of Neurology (Y.-S.L.), Seoul National University Boramae Medical Center; Department of Neurology (Y.D.K.), Yonsei University College of Medicine, Seoul, Korea; Department of Neurology (Y.H.), Peking University First Hospital, Beijing, China; Division of Neurology (K.S.W.), Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong; and Lysholm Department of Neuroradiology (H.R.J.), National Hospital for Neurology and Neurosurgery, London, UK.
² From the Stroke Research Centre (D.W., A.C., S.G., P.R., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery; Department of Statistical Science (G.A.) and Biomedical Research Centre (Z.V.F.), UCL, London, UK; Department of Neurosurgery (T.I.), Kushiro City General Hospital, Hokkaido, Japan; Department of Neurology (F.F.), University Hospital Würzburg, Germany; Department of Neurology (H.N.), Suiseikai Kajikawa Hospital, Hiroshima, Japan; Department of Neurology (S.H.), University of Heidelberg, Germany; Department of Stroke Medicine (R.V.), Division of Brain Sciences, Imperial College London; Nuffield Department of Clinical Neurosciences (P.M.R.), John Radcliffe Hospital, University of Oxford, UK; Department of Neurology (V.I.H.K.), Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands; Department of Neurology (V.T.), Austin Health and Melbourne Brain Center, University of Melbourne, Australia; Department of Neurology (Y.-S.L.), Seoul National University Boramae Medical Center; Department of Neurology (Y.D.K.), Yonsei University College of Medicine, Seoul, Korea; Department of Neurology (Y.H.), Peking University First Hospital, Beijing, China; Division of Neurology (K.S.W.), Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong; and Lysholm Department of Neuroradiology (H.R.J.), National Hospital for Neurology and Neurosurgery, London, UK. d.werring@ucl.ac.uk.

PMID: 27590288
PMCID: PMC5075978
DOI: 10.1212/WNL.0000000000003183

Meta-Analysis

Recurrent stroke risk and cerebral microbleed burden in ischemic stroke and TIA: A meta-analysis

Duncan Wilson et al. Neurology. 2016.

. 2016 Oct 4;87(14):1501-1510.

doi: 10.1212/WNL.0000000000003183. Epub 2016 Sep 2.

Authors

Affiliations

¹ From the Stroke Research Centre (D.W., A.C., S.G., P.R., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery; Department of Statistical Science (G.A.) and Biomedical Research Centre (Z.V.F.), UCL, London, UK; Department of Neurosurgery (T.I.), Kushiro City General Hospital, Hokkaido, Japan; Department of Neurology (F.F.), University Hospital Würzburg, Germany; Department of Neurology (H.N.), Suiseikai Kajikawa Hospital, Hiroshima, Japan; Department of Neurology (S.H.), University of Heidelberg, Germany; Department of Stroke Medicine (R.V.), Division of Brain Sciences, Imperial College London; Nuffield Department of Clinical Neurosciences (P.M.R.), John Radcliffe Hospital, University of Oxford, UK; Department of Neurology (V.I.H.K.), Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands; Department of Neurology (V.T.), Austin Health and Melbourne Brain Center, University of Melbourne, Australia; Department of Neurology (Y.-S.L.), Seoul National University Boramae Medical Center; Department of Neurology (Y.D.K.), Yonsei University College of Medicine, Seoul, Korea; Department of Neurology (Y.H.), Peking University First Hospital, Beijing, China; Division of Neurology (K.S.W.), Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong; and Lysholm Department of Neuroradiology (H.R.J.), National Hospital for Neurology and Neurosurgery, London, UK.
² From the Stroke Research Centre (D.W., A.C., S.G., P.R., D.J.W.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery; Department of Statistical Science (G.A.) and Biomedical Research Centre (Z.V.F.), UCL, London, UK; Department of Neurosurgery (T.I.), Kushiro City General Hospital, Hokkaido, Japan; Department of Neurology (F.F.), University Hospital Würzburg, Germany; Department of Neurology (H.N.), Suiseikai Kajikawa Hospital, Hiroshima, Japan; Department of Neurology (S.H.), University of Heidelberg, Germany; Department of Stroke Medicine (R.V.), Division of Brain Sciences, Imperial College London; Nuffield Department of Clinical Neurosciences (P.M.R.), John Radcliffe Hospital, University of Oxford, UK; Department of Neurology (V.I.H.K.), Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands; Department of Neurology (V.T.), Austin Health and Melbourne Brain Center, University of Melbourne, Australia; Department of Neurology (Y.-S.L.), Seoul National University Boramae Medical Center; Department of Neurology (Y.D.K.), Yonsei University College of Medicine, Seoul, Korea; Department of Neurology (Y.H.), Peking University First Hospital, Beijing, China; Division of Neurology (K.S.W.), Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong; and Lysholm Department of Neuroradiology (H.R.J.), National Hospital for Neurology and Neurosurgery, London, UK. d.werring@ucl.ac.uk.

PMID: 27590288
PMCID: PMC5075978
DOI: 10.1212/WNL.0000000000003183

Abstract

Objective: To determine associations between cerebral microbleed (CMB) burden with recurrent ischemic stroke (IS) and intracerebral hemorrhage (ICH) risk after IS or TIA.

Methods: We identified prospective studies of patients with IS or TIA that investigated CMBs and stroke (ICH and IS) risk during ≥3 months follow-up. Authors provided aggregate summary-level data on stroke outcomes, with CMBs categorized according to burden (single, 2-4, and ≥5 CMBs) and distribution. We calculated absolute event rates and pooled risk ratios (RR) using random-effects meta-analysis.

Results: We included 5,068 patients from 15 studies. There were 115/1,284 (9.6%) recurrent IS events in patients with CMBs vs 212/3,781 (5.6%) in patients without CMBs (pooled RR 1.8 for CMBs vs no CMBs; 95% confidence interval [CI] 1.4-2.5). There were 49/1,142 (4.3%) ICH events in those with CMBs vs 17/2,912 (0.58%) in those without CMBs (pooled RR 6.3 for CMBs vs no CMBs; 95% CI 3.5-11.4). Increasing CMB burden increased the risk of IS (pooled RR [95% CI] 1.8 [1.0-3.1], 2.4 [1.3-4.4], and 2.7 [1.5-4.9] for 1 CMB, 2-4 CMBs, and ≥5 CMBs, respectively) and ICH (pooled RR [95% CI] 4.6 [1.9-10.7], 5.6 [2.4-13.3], and 14.1 [6.9-29.0] for 1 CMB, 2-4 CMBs, and ≥5 CMBs, respectively).

Conclusions: CMBs are associated with increased stroke risk after IS or TIA. With increasing CMB burden (compared to no CMBs), the risk of ICH increases more steeply than that of IS. However, IS absolute event rates remain higher than ICH absolute event rates in all CMB burden categories.

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Figures

**Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow chart of study selection**

**Figure 2. Forest plot of the risk of ischemic stroke (IS) and intracerebral hemorrhage (ICH) for presence of any cerebral microbleeds (CMBs) vs no CMBs**
CI = confidence interval; RR = risk ratio.

**Figure 3. Forest plot of the risk of ischemic stroke (IS) for different burdens of cerebral microbleeds (CMBs) vs no CMBs**
CI = confidence interval; RR = risk ratio.

**Figure 4. Forest plot of the risk of intracerebral hemorrhage (ICH) for different burdens of cerebral microbleeds (CMBs) vs no CMBs**
CI = confidence interval; RR = risk ratio.

See this image and copyright information in PMC

References

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Recurrent stroke risk and cerebral microbleed burden in ischemic stroke and TIA: A meta-analysis

Affiliations

Recurrent stroke risk and cerebral microbleed burden in ischemic stroke and TIA: A meta-analysis

Authors

Affiliations

Abstract

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical