Assessment Of The Load And Distribution Of Cerebral Microbleeds On The Risk Of Recurrent Stroke In Cerebral Infarction Patients Caused By Large Artery Atherosclerosis

Objective: This investigation aimed at studying the influence of the load and distribution of cerebral microbleeds on recurrent stroke(ischemic and hemorrhagic)in cerebral infarction patients caused by Large artery atherosclerosis(LAA),providing fundamental secondary prevention for LAA stroke patients,guiding the clinicians formulate a safer and more scientific and reasonable secondary prevention treatment plan for survival patients with LAA stroke.Methods: A total of 181 patients with acute LAA stroke were prospectively enrolled from March 2019 to September 2020 with a median follow-up of 17 months.CMBs were analyzed using susceptibility weighted imaging(SWI)brain scan.All patients were divided into CMBs group and non-CMBs group according to the presence of CMBs.The site and quantity of CMBs were stratified according to the microbleed anatomic rating scale and brain observer microbleed scale.According to the number of CMBs,they were divided into the non-CMBS group(zero),the mild group(1-4 CMBs),the moderate group(5-9 CMBs)and the severe group(≥10 CMBs).According to the anatomical distribution of CMBs,they were divided into three groups: cerebral lobe type: cerebral lobes、Deep/subtentorial type: deep(thalamus,basal ganglia)or subtentorial brain tissue(brainstem,cerebellum)、Mixed type: both lobe and deep/subtentorial brain tissue are involved.The end points included recurrent stroke(both ischemic and hemorrhagic)and all-cause death.Cox regression model was used to evaluate the influence of the presence,load and distribution of CMBs on the risk of recurrent stroke(ischemic and hemorrhagic)in LAA stroke patients.Results: A total of 181 patients with LAA stroke were included in this study,including 79 patients in CMBs group,with a positive detection rate of 43.65%,and 102 patients without CMBs,accounting for 56.35%.During the follow-up period,there were23 patients(12.71%)happened recurrent ischemic stroke,3 patients(1.66%)cerebral hemorrhage,and 10 patients(5.52%)all-cause death.Multivariate Cox regression analysis showed that the presence,load and distribution of CMBs were not associated with recurrent ischemic stroke in LAA stroke patients.Hyperlipidemia(HR=3.159,95%CI=1.338-7.461,P=0.009)and previous history of cerebral infarction(HR=2.403,95%CI=1.059-5.540,P=0.036)were independent risk factors for recurrent ischemic stroke in LAA stroke patients.CMBs≥10(HR=14.96,95%CI=1.35-164.99,P=0.027)was an independent predictor of cerebral hemorrhage in LAA stroke patients,while the distribution of CMBs was not associated with the risk of cerebral hemorrhage after LAA stroke.Conclusion:1.CMBs has a high prevalence in LAA stroke patients;2.The presence,load and distribution of CMBs were not related to the recurrence of ischemic stroke in LAA stroke patients,hyperlipidemia and previous history of cerebral infarction were independent risk factors for ischemic stroke recurrence in LAA stroke patients;3.The distribution of CMBs was not associated with the risk of cerebral hemorrhage in LAA stroke patients.Severe CMBs(CMBs≥10)was an independent risk factor for cerebral hemorrhage after LAA stroke.