Pretreatment cerebral microbleeds and symptomatic intracerebral hemorrhage post-thrombolysis: a systematic review and meta-analysis

  • Jiangzhi Yan
  • Jianting Qiu
  • Xiumei Wu
  • Yonggui Ge
  • Jian Wang
  • Yujie WangEmail author


Background and purpose

Cerebral microbleeds (CMBs) are a possible predictor of symptomatic intracranial hemorrhage (sICH) and poor function outcome (PFO). We aimed to investigate the presence of CMBs on increased incidence of sICH and PFO in acute ischemic stroke patients receiving intravenous thrombolysis (IVT) treatment.


We searched PubMed, EMBASE, and Cochrane Library from 1 January 1997 to 13 May 2018, for relevant studies and calculated the pooled relative risk (RR) for the incidence of sICH and PFO in patients with CMBs versus those without after IVT.


We included 2407 participants from nine studies. The cumulative sICH incidence was higher in patients with CMBs (6%, 95% CI 4–8%) than that in patients without CMBs (4%, 95% CI 2–6%) with pooled RR 1.51 (95% CI, 1.04–2.21; P = 0.031). Four studies including 1550 patients reported data on 3- to 6-month PFO. The cumulative PFO incidence was higher in patients with CMBs (53%, 95% CI 47–59%) than that in patients without CMBs (41%, 95% CI 36–46%) with pooled RR 1.25 (95% CI 1.11–1.41; P = 0.000).


The pretreatment CMBs were associated with increased incidence of sICH and PFO in acute ischemic stroke patients receiving IVT. However, it was not convincing enough to set the presence of CMBs as contraindication to IVT.


Intravenous thrombolysis Cerebral microbleeds Symptomatic intracerebral hemorrhage Poor function outcome A systematic review and meta-analysis 



None of the authors received financial support for this manuscript.

Compliance with ethical standards

Conflicts of interest

The study authors received no funding and report no conflicts of interest.

Ethical standards

All studies in this review have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Supplementary material

415_2018_9156_MOESM1_ESM.docx (3.8 mb)
Supplementary material 1 (DOCX 3882 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Jiangzhi Yan
    • 1
  • Jianting Qiu
    • 1
  • Xiumei Wu
    • 1
  • Yonggui Ge
    • 1
  • Jian Wang
    • 1
  • Yujie Wang
    • 1
    Email author
  1. 1.Department of Neurology, Cerebrovascular Disease Center, People’s HospitalChina Medical UniversityShenyangPeople’s Republic of China

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