ARTICLE Predictors of new remote cerebral microbleeds after IV thrombolysis for ischemic stroke Tim Bastian Braemswig, MD, Kersten Villringer, MD, Guillaume Turc, MD, PhD, Hebun Erdur, MD, Jochen B. Fiebach, MD, Heinrich J. Audebert, MD, Matthias Endres, MD, Christian H. Nolte, MD,* and Jan F. Scheitz, MD* Neurology ® 2019;92:e1-e9. doi:10.1212/WNL.0000000000006915 Correspondence Dr. Braemswig tim-bastian.braemswig@ charite.de Abstract Objective To assess the frequency, associated factors, and underlying vasculopathy of new remote cerebral microbleeds (CMB), as well as the risk of concomitant hemorrhagic complications related to new CMBs, after IV thrombolysis (IVT) in acute stroke patients. Methods We conducted an observational study using data from our local thrombolysis registry. We included consecutive stroke patients with MRI (3T)-based IVT and a follow-up MRI the next day between 2008 and 2017 (n = 396). Only CMBs located outside of the ischemic lesions were considered. We also performed a meta-analysis on new CMBs after IVT that included 2 additional studies. Results In our cohort, new remote CMBs occurred in 16/396 patients (4.0%) after IVT and the distribution was strictly lobar in 13/16 patients (81%). Patients with preexisting CMBs with a strictly lobar distribution were significantly more likely to have new CMBs after IVT (p = 0.014). In the random-effects meta-analysis (n = 741), the pooled cumulative frequency of new CMBs after IVT was 4.4%. A higher preexisting CMB burden (>2) was associated with a higher likelihood of new CMBs (odds ratio [OR] 3.6, 95% confidence interval [CI] 1.3–10.3) and new CMBs were associated with the occurrence of remote parenchymal hemorrhage (OR 28.8, 95% CI 8.6–96.4). Conclusions New remote CMBs after IVT occurred in 4% of stroke patients, mainly had a strictly lobar distribution, and were associated with IVT-related hemorrhagic complications. Preexisting CMBs with a strictly lobar distribution and a higher CMB burden were associated with new CMBs after IVT, which may indicate an underlying cerebral amyloid angiopathy. RELATED ARTICLE Editorial Microbleeds evolution and remote hemorrhage post-tPA: Shades of “red meets white” revisited Page 307 *These authors contributed equally to this work. From the Klinik und Hochschulambulanz f¨ ur Neurologie (T.B.B., H.E., H.J.A., M.E., C.H.N., J.F.S.), Charit´ e–Universit¨ atsmedizin Berlin, Corporate Member of Freie Universit¨ at Berlin, Humboldt-Universit¨ at zu Berlin, and Berlin Institute of Health; Berlin Institute of Health (BIH) (T.B.B., H.E., M.E., C.H.N., J.F.S.), Berlin, Germany; Center for Stroke Research Berlin (CSB) (T.B.B., K.V., G.T., J.B.F., H.J.A., M.E., C.H.N., J.F.S.), Charit´ e – Universit¨ atsmedizin Berlin, Berlin, Germany; Department of Neurology (G.T.), Hˆ opital Sainte-Anne, Universit´ e Paris Descartes; INSERM U894 (G.T.), France; DZHK (German Centre for Cardiovascular Research) (M.E., C.H.N., J.F.S.), partner site Berlin, Berlin, Germany; German Center for Neurode- generative Diseases (DZNE) (M.E.), partner site Berlin, Berlin, Germany. Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article. Copyright © 2019 American Academy of Neurology e1 Copyright ª 2019 American Academy of Neurology. Unauthorized reproduction of this article is prohibited. Published Ahead of Print on January 23, 2019 as 10.1212/WNL.0000000000006915