Prevalence and Risk Factors for Cerebral Microbleeds in Chinese Patients With Acute Ischemic Stroke

BACKGROUND: Cerebral microbleeds (CMBs) are recognized as significant markers in acute ischemic stroke (AIS). Although prior studies conducted in southern China have reported CMB prevalence ranging from 27.8% to 56.7% among patients with AIS, data from northern China remain limited, and associated risk factors are not well defined. The aim of this study was to assess the prevalence and determinants of CMBs in a cohort of Chinese patients with AIS. METHODS: In this hospital-based retrospective study, 171 consecutive patients diagnosed with AIS were assessed for the presence, number, and anatomical distribution of CMBs using standardized 3.0 Tesla susceptibility-weighted magnetic resonance imaging protocols. Baseline demographic and clinical variables were collected and analyzed in relation to CMB presence, burden, and location. RESULTS: The cohort (mean age 64.8 ± 13.0 years; 73.7% male) demonstrated a CMB prevalence of 49.1%, with variation across TOAST subtypes: large artery atherosclerosis (LAA) (59.4%), small vessel disease (SVD) (47.5%), cardioembolism (21.4%), and other etiologies (25.0%). Multivariate logistic regression identified hypertension (adjusted odds ratio [AOR] = 2.07, 95% confidence interval [CI]: 1.01-4.24) and severe white matter hyperintensity (WMH) (AOR = 4.38, 95% CI: 1.69-11.35) as independent risk factors for the presence of CMBs. Patients with ≥ 3 CMBs had a significantly higher proportion of SVD subtype (58.1% vs. 31.7%, p < 0.01) and lower levels of low-density lipoprotein cholesterol (1.85 vs. 2.38 mmol/L, p < 0.01) when compared with those with 1-2 CMBs. Deep and infratentorial CMBs were associated with a higher frequency of SVD (59.3% and 51.4% vs. 15.0%, p < 0.01) and moderate-to-severe WMH (51.8% and 81.0% vs. 45.0%, p < 0.05) when compared with strictly lobar CMBs. CONCLUSION: Approximately half of the patients with AIS exhibited CMBs, particularly those classified under LAA and SVD subtypes. Hypertension and severe WMH were independently associated with CMB presence. Distinct clinical profiles were observed based on CMB burden and location. Further research is warranted to elucidate underlying mechanisms and clinical implications.