DISTRIBUTION OF CEREBRAL MICROBLEED IN THE EAST AND WEST IN PATIENTS ISCHEMIC STROKE AND TIA: A POOLED ANALYSIS OF INDIVIDUAL PATIENT DATA FROM COHORT STUDIES

초록

Background and Aims: We investigated differences in the distribution of cerebral microbleed (CMB) on MRI, hypothesizing that distribution would differ between Eastern and Western patients with ischemic stroke (IS) or transient ischemic attack (TIA). Methods: This study used pooled individual patient data from the Microbleeds International Collaborative Network composed with 37 prospective cohort studies from 18 countries. IS/TIA patients with blood-sensitive MRI sequence were categorized by geographical location (Eastern or Western), and CMB distribution (strictly lobar or deep and/or infratentorial [D/I] or mixed). We tested if IS/TIA patients had different distributions of CMB by location using multivariable mixed effects logistic regression analyses adjusted for vascular risk factors (age, sex, hypertension, atrial fibrillation), blood-sensitive MRI protocol (i.e. GE-MRI/SWI) and clustering by institution. Results: Among 19,176 patients (mean age, 70.2 years; 54% from Western; 28.7% with CMB), there were no differences in vascular risk factors, but GE-MRI was more commonly performed in the West. The prevalence of strictly lobar CMB was 9.2%, and of D/I or mixed CMB was 18.7%. In multivariable mixed effects models, the Eastern group had higher odds of D/I or mixed CMBs (adjusted odds ratio 1.65, 95% confidence interval [CI] 1.15-2.36) compared to the Western group. The Eastern group also had a higher number of D/I or mixed CMBs (adjusted prevalence ratio 1.85, 95%CI 1.25-2.73). Conclusions: Eastern and Western IS/TIA patients have different anatomical distributions of CMB, suggesting differences in the spectrum of predominant underlying small vessel diseases, with potential implications for racial differences in intracerebral hemorrhage risk during antithrombotic therapy.