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Ischemia in intracerebral hemorrhage: A comparative study of small-vessel and large-vessel diseases

Ailing Zhang1,2, Mengyang Ren1, Wenjing Deng3

  • 1Department of Neurology, People's Hospital of Zhengzhou, Zhengzhou, China.

Annals of Clinical and Translational Neurology
|January 12, 2022
PubMed

Insights

Cerebral small-vessel disease burden links to small ischemic lesions in intracerebral hemorrhage. Severe artery stenosis is linked to large lesions, especially with significant blood pressure changes.

Area of Science:

  • Neurology
  • Neuroimaging
  • Vascular Neurology

Background:

  • Cerebral small-vessel disease (cSVD) and cerebral artery stenosis (CAS) are common in patients with acute intracerebral hemorrhage (ICH).
  • The interplay between cSVD, CAS, and acute ischemic lesions in ICH is not fully understood.
  • Mean arterial pressure (MAP) changes may influence the relationship between vascular pathologies and ischemic events.

Purpose of the Study:

  • To compare the effects of cSVD burden and CAS on acute ischemic lesions in ICH.
  • To investigate the interaction between cSVD, CAS, and MAP change in the context of acute ischemic lesions.
  • To differentiate the pathogenetic mechanisms underlying small-vessel versus large-artery disease in ICH-related ischemia.

Main Methods:

  • Recruitment of consecutive patients with acute primary ICH.
  • Brain MRI and MRA for quantifying diffusion-weighted imaging (DWI) lesions, CAS, and cSVD markers.
  • Multivariable regression models stratified by DWI lesion size and median MAP change.

Main Results:

  • Small DWI lesions were associated with a higher total cSVD score (OR 1.81).
  • Large DWI lesions were associated with more severe CAS (OR 2.51).
  • MAP change modified the association between severe CAS and large DWI lesions (interaction p=0.016), with a higher risk observed with greater MAP change (OR 3.48).

Conclusions:

  • Total cSVD burden is linked to small ischemic lesions, suggesting small-vessel disease pathogenesis.
  • CAS is associated with large ischemic lesions, particularly when accompanied by significant MAP changes, indicating potential large-artery atherosclerosis involvement.
  • These findings highlight distinct mechanisms for small-vessel and large-artery disease in ICH-related ischemic brain injury.
Abstract

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