Number of cerebral microbleeds after intracranial/extracranial stenting and dual antiplatelet therapy.

ABSTRACT

BACKGROUND: Cerebral microbleeds (CMBs) are small (<1 cm) perivascular hemosiderin depositions. They may be visible in T2* or susceptibility-weighted magnetic resonance imaging (MRI) sequences. CMBs may indicate an increased risk of intracerebral hemorrhage (ICH) or vascular disease. Cerebral white matter changes indicate small vessel disease (SVD), which is also related to CMBs. In cerebral vascular treatment, dual antiplatelet therapy (DAPT) is routinely used after stenting. We surveyed our cerebral stenting case series for changes in the number of CMBs. METHODS: Patients receiving extracranial or intracranial stenting between 2018 and 2020 were included. All patients received DAPT after stenting. Changes in CMBs, SVD degree, and other findings from pretreatment to follow-up MRI were recorded. Differences between stented artery supplying territory and other territories were compared. RESULTS: The average age of the 75 enrolled patients was 65.37 years ± 11.53 (50 male and 25 female patients); 84 extracranial or intracranial stentings were performed. The average Fazekas scale score was 1.32 ± 0.77. Significantly more CMBs developed in the initial ≥6 CMB group than in the initial 0 and 1-5 CMB groups (7 ± 3.6 vs 0.56 ± 1.06, 1.45 ± 3.32, p < 0.001). No significant difference in increased CMBs was observed between the initial 0 and 1-5 CMB groups. Significantly more CMBs developed in the stented artery supplying territory than elsewhere (0.6 ± 0.13 vs 0.44 ± 0.17, p < 0.05). No ICH was noted in our case series. CONCLUSION: Preexisting CMB was a risk factor for the onset of new CMBs after stenting and DAPT. Poststenting and DAPT statistically increased CMBs in stented artery supplying territories at short-term follow-up.