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Intracerebral Hemorrhage Recurrence in Patients with and without Cerebral Amyloid Angiopathy
João Pinho1, José Manuel Araújo2, Ana Sofia Costa3,4
1Department of Neurology, University Hospital RWTH Aachen, Aachen, Germany, jferreiradep@ukaachen.de.
Insights
Patients with cerebral amyloid angiopathy (CAA) have higher risk of intracerebral hemorrhage (ICH) recurrence. Age, cortical superficial siderosis (cSS), and enlarged perivascular spaces (EPVS) are associated with ICH recurrence.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- Intracerebral hemorrhage (ICH) recurrence is more frequent in patients with cerebral amyloid angiopathy (CAA).
- Risk factors for ICH recurrence require further elucidation, particularly imaging markers of microangiopathy.
Purpose of the Study:
- To investigate specific imaging markers of microangiopathy associated with ICH recurrence in patients with and without CAA.
- To identify predictors of ICH recurrence in a cohort of non-traumatic ICH patients.
Main Methods:
- Retrospective case-control study of 104 non-traumatic ICH patients (2014-2017) with MRI.
- Comparison of CAA-related ICH and CAA-unrelated ICH groups based on Boston criteria.
- Survival analysis using Kaplan-Meier curves and Cox regression to assess ICH recurrence-free survival.
Main Results:
- CAA-related ICH patients showed higher burdens of microbleeds, enlarged perivascular spaces (EPVS) in centrum semiovale, and cortical superficial siderosis (cSS).
- ICH recurrence occurred at 12.7 per 100 person-years in CAA patients, with no recurrence in non-CAA patients.
- Age (HR 1.05), disseminated cSS (HR 3.32), and EPVS burden in centrum semiovale (HR 1.80) were associated with ICH recurrence.
Conclusions:
- This study confirms a higher ICH recurrence risk in patients with CAA-related ICH.
- Age, disseminated cSS, and EPVS burden in the centrum semiovale are significant predictors of ICH recurrence.
Background:
Intracerebral hemorrhage (ICH) recurrence risk is known to be higher in patients with cerebral amyloid angiopathy (CAA) as compared to other causes of ICH. Risk factors for ICH recurrence are not completely understood, and our goal was to study specific imaging microangiopathy markers.
Methods:
Retrospective case-control study of patients with non-traumatic ICH admitted to a single center between 2014 and 2017 who underwent magnetic resonance imaging (MRI). Clinical characteristics of the index event and occurrence of death and ICH recurrence were collected from clinical records. MRI images were independently reviewed by 2 neuroradiologists. Groups of patients with CAA-related and CAA-unrelated ICH defined were compared. Presence of CAA was defined according to the Boston modified criteria. Survival analysis with Kaplan-Meier curves and Cox-regression analyses was performed to analyze ICH recurrence-free survival.
Results:
Among 448 consecutive patients with non-traumatic ICH admitted during the study period, 104 were included in the study, mean age 64 years (±13.5), median follow-up of 27 months (interquartile range, IQR 16-43), corresponding to 272 person-years of total follow-up. CAA-related ICH patients presented higher burden of lobar microbleeds (p < 0.001), higher burden of enlarged perivascular spaces (EPVS) in centrum semiovale (p < 0.001) and more frequently presented cortical superficial siderosis (cSS; p < 0.001). ICH recurrence in patients with CAA was 12.7 per 100 person-years, and no recurrence was observed in patients without CAA. Variables associated with ICH recurrence in the whole population were age (hazard ratio [HR] per 1-year increment = 1.05, 95% CI 1.00-1.11, p = 0.046), presence of disseminated cSS (HR 3.32, 95% CI 1.09-10.15, p = 0.035) and burden of EPVS in the centrum semiovale (HR per 1-point increment = 1.80, 95% CI 1.04-3.12, p = 0.035).
Conclusions:
This study confirms a higher ICH recurrence risk in patients with CAA-related ICH and suggests that age, disseminated cSS, and burden of EPVS in the centrum semiovale are associated with ICH recurrence.
