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Updated: Nov 17, 2025
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Long-term prognosis after intracerebral haemorrhage
Koen M van Nieuwenhuizen1, Ilonca Vaartjes2, Jamie I Verhoeven3
1Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.
Insights
Intracerebral haemorrhage (ICH) survivors face high risks of recurrent ICH, stroke, and vascular events, with significantly reduced survival rates. These findings highlight the need for improved secondary prevention strategies.
Area of Science:
- Neurology
- Epidemiology
- Public Health
Background:
- Intracerebral haemorrhage (ICH) survivors have increased risks for subsequent vascular events and mortality.
- Understanding these risks stratified by age and sex is crucial for effective patient management and secondary prevention.
Purpose of the Study:
- To determine the 30-day and long-term risks of recurrent ICH, ischemic stroke, all stroke, any vascular event, and all-cause mortality in ICH survivors.
- To analyze these risks based on patient age and sex.
Main Methods:
- A cohort of 19,444 Dutch 30-day ICH survivors (1998-2010) was identified using national registers.
- Cumulative incidences were calculated, adjusted for competing risks, and survival was compared to the general population.
Main Results:
- First-year recurrent ICH risk ranged from 1.5% to 2.4%.
- Ten-year risks varied by age and sex: recurrent ICH (3.7%-8.1%), ischemic stroke (2.6%-7.0%), all stroke (9.9%-26.2%), and any vascular event (15.0%-40.4%).
- Ten-year mortality ranged from 16.7% to 90.0%, with significantly reduced relative survival across all groups.
Conclusions:
- ICH survivors are at a high risk for recurrent ICH, other vascular events, and experience prolonged reduced survival.
- These elevated risks underscore the necessity for clinical trials to establish optimal secondary prevention treatments post-ICH.
Introduction:
The aim of this study was to determine the risk of recurrent intracerebral haemorrhage (ICH), ischaemic stroke, all stroke, any vascular event and all-cause mortality in 30-day survivors of ICH, according to age and sex.
Patients And Methods:
We linked national hospital discharge, population and cause of death registers to obtain a cohort of Dutch 30-day survivors of ICH from 1998 to 2010. We calculated cumulative incidences of recurrent ICH, ischaemic stroke, all stroke and composite vascular outcome, adjusted for competing risk of death and all-cause mortality. Additionally, we compared survival with the general population.
Results:
We included 19,444 ICH-survivors (52% male; median age 72 years, interquartile range 61-79; 78,654 patient-years of follow-up). First-year cumulative incidence of recurrent ICH ranged from 1.5% (95% confidence interval 0.9-2.3; men 35-54 years) to 2.4% (2.0-2.9; women 75-94 years). Depending on age and sex, 10-year risk of recurrent ICH ranged from 3.7% (2.6-5.1; men 35-54 years) to 8.1% (6.9-9.4; women 55-74 years); ischaemic stroke 2.6% to 7.0%, of all stroke 9.9% to 26.2% and of any vascular event 15.0% to 40.4%. Ten-year mortality ranged from 16.7% (35-54 years) to 90.0% (75-94 years). Relative survival was lower in all age-groups of both sexes, ranging from 0.83 (0.80-0.87) in 35- to 54-year-old men to 0.28 (0.24-0.32) in 75- to 94-year-old women.
Discussion:
ICH-survivors are at high risk of recurrent ICH, of ischaemic stroke and other vascular events, and have a sustained reduced survival rate compared to the general population.
Conclusion:
The high risk of recurrent ICH, other vascular events and prolonged reduced survival-rates warrant clinical trials to determine optimal secondary prevention treatment after ICH.
