Cerebral Microbleeds in a Stroke Prevention Clinic (P5.235)

Objective: We hypothesized that management of cerebral microbleeds (CMB) patients by a stroke neurologist attentive to the complexities of coexisting ischemic and hemorrhagic cerebrovascular disease (“mixed cerebrovavascular disease”) would result in effective stroke prevention. Background: CMB are foci of microhemorrhages, common in the aging brain. The need to prevent ischemic stroke while not provoking hemorrhagic stroke or worsening CMB is a common problem. The impact of CMB on long-term outcome (stroke prevention) is an important issue. Design/Methods: We retrospectively reviewed records of patients treated by a single strokeneurologist in a stroke prevention clinic between 2011 and 2017. We identified patients with CMB studied with MRI susceptibility-weighted imaging, along with clinical variables including age, sex, vascular risk factors, medications, and laboratory findings. Likelyetiology of CMB was determined, eg, hypertension (HTN), cerebral amyloidangiopathy (CAA), chronic kidney disease (CKD), and secondary microbleeds (hemorrhagicinfarction or microinfarction). The primary outcome was ischemic or hemorrhagic stroke during follow-up. Secondary outcome was progression of CMB, defined as increase in number of CMB on follow-up MRI. We analyzed factors relating to prevalence of clinical events and progression of CMB. All patients were treated with strict attention to blood pressure control and judicious use of antithrombotic medications. Results: Among 348 stroke clinic patients, 66 (19%) with CMB were analyzed (47% White, 33% Asian, 15% Hispanic, 5% African-American). 30 were male and mean±SD of age was 76.9±11.2 years. The most common cause of CMB was HTN alone (32/66, 48%), followed by the combination of HTN and CKD (11/66, 17%), and HTN and CAA (10/66, 15%). Conclusions: During two years of follow-up in this stroke prevention clinic cohort, progression of CMB was common, but clinical stroke was relatively uncommon and hemorrhagic stroke was rare. These findings suggest a relatively benign clinical course for CMB patients with management by a stroke neurologist. Study Supported by: NS20989 Disclosure: Dr. Cho has nothing to disclose. Dr. Shah has nothing to disclose. Dr. Floriolli has nothing to disclose. Dr. Paganini-Hill has nothing to disclose. Dr. Fisher has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Expert witness consulting. Dr. Fisher has received research support from Boehringer-Ingelheim, Ostuka Pharmaceutical Co.