Abstract Details

Title Cerebral Microbleeds And White Matter Hyperintensities Are Not Associated With Increased Risk of Hemorrhagic Transformation In Acute Ischemic Stroke Without Intravenous Thrombolysis

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P1 - Poster Session 1 (12:00 PM-1:00 PM)

Poster/Presentation
Number 4-021

Objective

To determine the risk of hemorrhagic transformation (HT) in acute ischemic strokes (AIS) based on presence of cerebral microbleeds (CMB) and extent of FLAIR white matter hyperintensities (WMH) in absence of intravenous tissue plasminogen activator (IV t-PA).

Background Administration of IV t-PA for AIS has demonstrated increased risk of HT, which is further increased by presence of CMB. To our knowledge, risk of HT in the absence of IV t-PA stratified by CMB and WMH is unclear.

Design/Methods

Retrospective chart review of AIS patients admitted between 7/1/2015 - 6/30/2016. Study included patients with confirmed AIS on MRI brain with evaluable DWI, FLAIR, and SWI who did not receive stroke intervention. CMB was evaluated on SWI using the microbleed anatomical rating scale (MARS) and further grouped based on number of CMB (0, 1-5, >5). HT was evaluated based on ECASS classification. WMH was graded on FLAIR using Fazekas scale and grouped into 0-3 and 4-6 for total score.

Results There was a total of 195 patients with mean age 66.5 years and mean admission NIHSS 6, including 51% women and 74% whites. CMB was noted in 69 (35.4%) patients – 51 with 1-5 CMB and 18 with more than 5 CMB. Total WMH score of 0-3 on Fazekas scale was noted in 122 (63%) and score of 4-6 in 73 (37%) patients. HT was observed in 21 patients – hemorrhagic infarction Type 1 in 9, Type 2 in 7 patients and parenchymal hemorrhage Type 1 in 2, Type 2 in 3 patients. Presence of CMB (p=0.83) or number of CMB (p=0.75) and extent of WMH based on Fazekas score (p=0.68) was not associated with HT or discharge outcome to home.

Conclusions In the absence of IV thrombolysis, CMB and severity of WMH are not associated with increased risk of hemorrhagic transformation in acute ischemic strokes.

Authors/Disclosures
Amreen Farooqui, MD (University of Florida, Department of Neurology) PRESENTER	Dr. Farooqui has nothing to disclose.
Abdullah Bin Zahid, MD (Johns Hopkins University)	No disclosure on file
Nandakumar Nagaraja, MD (Penn State Health Milton S. Hershey Medical Center)	The institution of Dr. Nagaraja has received research support from 1 Florida Alzheimer's Disease Research Center. Dr. Nagaraja has received personal compensation in the range of $500-$4,999 for serving as a stroke outcome adjudicator for WHI study with Fred Hutchinson Cancer Research Center.