Factors associated with cerebral microbleeds detected after intravenous thrombolysis in acute ischemic stroke patients based on SWI.

OBJECTIVE

To investigate the independent factors associated with the detection of cerebral microbleeds (CMBs) after intravenous thrombolysis (IVT) in patients with acute ischemic stroke (AIS) based on susceptibility-weighted imaging (SWI).

METHODS

This was a retrospective analysis of 157 AIS patients who received IVT. Based on post-thrombolysis SWI findings, patients were divided into a CMBs+ group (n = 75) and a CMBs- group (n = 82). Clinical data were collected. Univariate analysis was used to screen variables, and those with p < 0.05 were incorporated into a multivariate logistic regression model to identify independent factors associated with CMBs.

RESULTS

Univariate analysis showed that activated partial thromboplastin time (APTT), international normalized ratio (INR), smoking history, history of lacunar infarction, white matter hyperintensities (WMH), and history of antithrombotic medication use were associated with CMB occurrence (p < 0.05). Multivariate analysis further confirmed that WMH (OR = 29.92, 95% CI: 6.94-128.95), history of lacunar infarction (OR = 17.70, 95% CI: 5.00-62.61), and smoking history (OR = 4.55, 95% CI: 1.37-15.16) were independent factors associated with CMBs (p < 0.05). Age, pre-thrombolysis NIHSS score, and coagulation parameters did not enter the final model.

CONCLUSION

Cerebral small vessel disease (manifested as white matter hyperintensities and lacunar infarction) is the most significant factor associated with CMBs detected after IVT, and smoking is an important modifiable behavioral risk factor. Clinical decision‑making should pay particular attention to AIS patients with markers of cerebral small vessel disease.