Zunahme von zerebralen Mikroblutungen nach Initiierung einer Sekundärprophylaxe nach ischämischem Schlaganfall

Background – Cerebral microbleeds (CMBs) are a marker of vascular damage in the brain and represent a risk for further ischemic stroke and intracerebral hemorrhage (ICH). They are known to be more prevalent in patients who use antithrombotic drugs. Patients who are at higher risk for the development of CMBs need to be identified in order to evaluate the best post stroke treatment. Methods – We examined 58 patients who either had a first ischemic stroke or transitory ischemic attack (TIA) and for whom a secondary prevention with a platelet aggregation inhibitor was initiated. In the first week after the onset of a stroke and six months later, a 3T MRI was performed. CMBs were counted and classified into deep, lobar and infratentorial by two independent raters. After adjustment for cerebrovascular risk factors, etiology of stroke and severity of stroke, patients with and without CMBs at baseline were compared to figure out which patients developed more new CMBs after six months under antiplatelet drug treatment. Results – New CMBs occurred in 16 patients (40%) after six months. An increase of CMBs was found in 50% of patients with CMBs at baseline vs. 34.6% in patients without. Number of CMBs at baseline correlated with the number of new CMBs (0.007) with a cut-off value of four CMBs at baseline. Associated to the number of new CMBs were male gender (0.049), age over 70 years (0.020), number of risk factors (0.021) and NIHSS score (0.018). Atherothrombotic stroke was correlated to the development of new CMBs (0.003), whereas cardioembolic stroke was strictly negatively correlated (0.017). Conclusions – Patients with CMBs at baseline are at higher risk to develop new CMBs under antithrombotic drug treatment than patients without CMBs. This applies in particularly to patients with multiple CMBs. The clinical consequences still have to be figured out, especially the risk for further ischemic stroke and intracerebral hemorrhage.