Abstract
OBJECTIVES: This study aims to investigate the prognostic implications of cerebral microbleeds (CMBs) in patients with large artery atherosclerotic stroke (LAAS) without thrombolytic therapy, mainly focusing on the association between CMBs and clinical outcomes, such as recurrent ischemic stroke (IS), intracranial hemorrhage (ICH), and all-cause mortality. METHODS: A retrospective cohort study was conducted on 353 LAAS patients (January 2016-October 2021) at the Affiliated Hospital of Qingdao University. All underwent susceptibility-weighted imaging (SWI) and received single or dual antiplatelet therapy. CMBs were classified by location (lobar, deep, and infratentorial) and severity. Kaplan-Meier survival analysis and Cox regression models were used to assess endpoint events. RESULTS: Among the 353 patients, 147 had CMBs. Significant differences in age, fasting blood glucose levels, and history of hypertension were observed between patients with and without CMBs. Age and hypertension were identified as independent risk factors for CMBs. Patients with CMBs had a significantly higher incidence of recurrent IS and all-cause mortality compared to those without CMBs. Recurrent IS, ICH, and all-cause mortality were defined as the primary endpoint events in this study. The mean time to endpoint events was shorter in patients with CMBs (59.2 months) compared to those without CMBs (79.1 months). The location of CMBs influenced the prognosis, with deep or infratentorial CMBs associated with higher mortality. However, CMB location does not significantly influence the risk of IS or ICH. Single or dual antiplatelet therapy did not significantly alter the risk of endpoint events in patients with CMBs. CONCLUSIONS: The presence of CMBs, particularly in deep or infratentorial regions, significantly worsens the prognosis of LAAS patients without thrombolytic therapy. Patients with CMBs have a higher risk of recurrent IS and all-cause mortality, but no significant difference in ICH incidence compared to those without CMBs. CMB burden had no differential effect on the efficacy of single antiplatelet therapy (SAPT) or double antiplatelet therapy (DAPT). Further prospective studies are necessary to validate these findings and explore alternative therapeutic strategies.