Evidence map›Paper›PMID 27088650›Full record

SynthesisJAMA neurology2016

Risk of Symptomatic Intracerebral Hemorrhage After Intravenous Thrombolysis in Patients With Acute Ischemic Stroke and High Cerebral Microbleed Burden: A Meta-analysis.

Georgios Tsivgoulis, Ramin Zand, Aristeidis H Katsanos, Guillaume Turc, Christian H Nolte, Simon Jung, Charlotte Cordonnier, Jochen B Fiebach, Jan F Scheitz, Pascal P Klinger-Gratz and 7 more

Open access · bronzeAbstract readMeta-Analysis
PubMed Publisher
In one paragraph

Synthesis in JAMA neurology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 85 papers, 9 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
85citing papers in PubMed, 9 pooled it
18.4field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

85 citing papers in PubMed, 9 syntheses or guidelines pooled it, 179 citations in OpenAlex.

  1. Pooled it
  2. Intracranial hemorrhage risk in patients with cerebral microbleeds after mechanical thrombectomy for acute ischemic stroke: a systematic review and meta-analysis.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2024
    Pooled it
  3. Pooled it
  4. Guideline
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  6. Pooled it
  7. Guideline
  8. Pooled it
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  10. Cerebral microbleeds and asundexian in non-cardioembolic ischemic stroke: Secondary analyses of the PACIFIC-STROKE randomized trial.International journal of stroke : official journal of the International Stroke Society · 2024
    Trial
  11. Trial
  12. Stroke Warning Information and Faster Treatment (SWIFT): Cost-Effectiveness of a Stroke Preparedness Intervention.Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research · 2019
    Trial
  13. Article
  14. Observational
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  18. Article
  19. Clinical Management of Cerebral Amyloid Angiopathy.Journal of clinical medicine · 2025
    Review
  20. Review

25 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

17 authors at 9 institutions in 7 countries.

Georgios TsivgoulisDepartment of Neurology, The University of Tennessee Health Science Center, Memphis2Second Department of Neurology, Attikon Hospital, School of Medicine, University of Athens, Athens, Greece3International Clinical Research Center, Department of Neurology.
Ramin ZandDepartment of Neurology, The University of Tennessee Health Science Center, Memphis.
Aristeidis H KatsanosSecond Department of Neurology, Attikon Hospital, School of Medicine, University of Athens, Athens, Greece4Department of Neurology, University of Ioannina School of Medicine, Ioannina, Greece.
Guillaume TurcDepartment of Neurology, Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, Inserm UMR S894, Départements Hospitalo-Universitaires Neurovasc, Paris, France.
Christian H NolteKlinik und Hochschulambulanz für Neurologie and Center for Stroke Research, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Simon JungDepartment of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland8Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
Charlotte CordonnierUniversity Lille, Inserm, Centre Hospitalier Régional Universitaire de Lille, U1171, Degenerative and Vascular Cognitive Disorders, Lille, France.
Jochen B FiebachKlinik und Hochschulambulanz für Neurologie and Center for Stroke Research, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Jan F ScheitzKlinik und Hochschulambulanz für Neurologie and Center for Stroke Research, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Pascal P Klinger-GratzDepartment of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
Catherine OppenheimDepartment of Radiology, Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, Inserm UMR S894, Départements Hospitalo-Universitaires Neurovasc, Paris, France.
Nitin GoyalDepartment of Neurology, The University of Tennessee Health Science Center, Memphis.
Apostolos SafourisSecond Department of Neurology, Attikon Hospital, School of Medicine, University of Athens, Athens, Greece11Acute Stroke Unit, Metropolitan Hospital, Piraeus, Greece.
Heinrich P MattleDepartment of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
Anne W AlexandrovDepartment of Neurology, The University of Tennessee Health Science Center, Memphis12Australian Catholic University, Sydney, Australia.
Peter D SchellingerDepartments of Neurology and Neurogeriatry, Johannes Wesling Medical Center, Minden, Germany.
Andrei V AlexandrovDepartment of Neurology, The University of Tennessee Health Science Center, Memphis.
Charité - Universitätsmedizin Berlin · DEInserm · FRUniversity of Bern · CHUniversity of Tennessee Health Science Center · USAustralian Catholic University · AUJohannes Wesling Klinikum Minden · DENational and Kapodistrian University of Athens · GRSt. Anne's University Hospital Brno · CZUniversity General Hospital Attikon · GR

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

importanceCerebral microbleeds (CMBs) have been established as an independent predictor of cerebral bleeding. There are contradictory data regarding the potential association of CMB burden with the risk of symptomatic intracerebral hemorrhage (sICH) in patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT).

objectiveTo investigate the association of high CMB burden (>10 CMBs on a pre-IVT magnetic image resonance [MRI] scan) with the risk of sICH following IVT for AIS. DATA SOURCES: Eligible studies were identified by searching Medline and Scopus databases. No language or other restrictions were imposed. The literature search was conducted on October 7, 2015. This meta-analysis has adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was written according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) proposal. STUDY SELECTION: Eligible prospective study protocols that reported sICH rates in patients with AIS who underwent MRI for CMB screening prior to IVT. DATA EXTRACTION AND SYNTHESIS: The reported rates of sICH complicating IVT in patients with AIS with pretreatment MRI were extracted independently for groups of patients with 0 CMBs (CMB absence), 1 or more CMBs (CMB presence), 1 to 10 CMBs (low to moderate CMB burden), and more than 10 CMBs (high CMB burden). An individual-patient data meta-analysis was also performed in the included studies that provided complete patient data sets. MAIN OUTCOMES AND MEASURES: Symptomatic intracerebral hemorrhage based on the European Cooperative Acute Stroke Study-II definition (any intracranial bleed with ≥4 points worsening on the National Institutes of Health Stroke Scale score).

resultsWe included 9 studies comprising 2479 patients with AIS. The risk of sICH after IVT was found to be higher in patients with evidence of CMB presence, compared with patients without CMBs (risk ratio [RR], 2.36; 95% CI, 1.21-4.61; P = .01). A higher risk for sICH after IVT was detected in patients with high CMB burden (>10 CMBs) when compared with patients with 0 to 10 CMBs (RR, 12.10; 95% CI, 4.36-33.57; P < .001) or 1 to 10 CMBs (RR, 7.01; 95% CI, 3.20-15.38; P < .001) on pretreatment MRI. In the individual-patient data meta-analysis, high CMB burden was associated with increased likelihood of sICH before (unadjusted odds ratio, 31.06; 95% CI, 7.12-135.44; P < .001) and after (adjusted odds ratio, 18.17; 95% CI, 2.39-138.22; P = .005) adjusting for potential confounders. CONCLUSIONS AND RELEVANCE: Presence of CMB and high CMB burdens on pretreatment MRI were independently associated with sICH in patients with AIS treated with IVT. High CMB burden may be included in individual risk stratification scores predicting sICH risk following IVT for AIS.

Indexed as

Administration, IntravenousBrain IschemiaCerebral HemorrhageDatabases, BibliographicFibrinolytic AgentsHumansMagnetic Resonance ImagingRisk FactorsStrokeFibrinolytic Agents

Identifiers

PMID27088650
OpenAlexW2341400080

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.