Risk of intracranial haemorrhage and ischaemic stroke after convexity subarachnoid haemorrhage in cerebral amyloid angiopathy: international individual patient data pooled analysis

Objective To investigate the frequency, time-course and predictors of intracerebral haemorrhage (ICH), recurrent convexity subarachnoid haemorrhage (cSAH), and ischemic stroke after cSAH associated with cerebral amyloid angiopathy (CAA). Methods We performed a systematic review and international ind...

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Detalles Bibliográficos
Autores: Hostettler, IC, Wilson, D, Fiebelkorn, CA, Aum, D, Ameriso, SF, Eberbach, F, Beitzke, M, Kleinig, T, Phan, T, Marchina, S, Schneckenburger, R, Carmona-Iragui, M, Charidimou, A, Mourand, I, Parreira, S, Ambler, G, Jager, HR, Singhal, S, Ly, J, Ma, H, Touze, E, Geraldes, R, Fonseca, AC, Melo, T, Labauge, P, Lefevre, PH, Viswanathan, A, Greenberg, SM, Fortea, J, Apoil, M, Boulanger, M, Viader, F, Kumar, S, Srikanth, V, Khurram, A, Fazekas, F, Bruno, V, Zipfel, GJ, Refai, D, Rabinstein, A, Graff-Radford, J, Werring, DJ
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2022
País:España
Institución:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
Repositorio:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
OAI Identifier:oai:iibsantpau.fundanetsuite.com:p4522
Acceso en línea:https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=4522
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85111091526&doi=10.1007%2fs00415-021-10706-3&partnerID=40&md5=39973f81957062513b91b66885d6341f
Access Level:acceso abierto
Palabra clave:Non-traumatic convexity
convexal
cortical subarachnoid haemorrhage
Intracerebral haemorrhage
Ischemic stroke
Cerebral amyloid angiopathy
Stroke
Descripción
Sumario:Objective To investigate the frequency, time-course and predictors of intracerebral haemorrhage (ICH), recurrent convexity subarachnoid haemorrhage (cSAH), and ischemic stroke after cSAH associated with cerebral amyloid angiopathy (CAA). Methods We performed a systematic review and international individual patient-data pooled analysis in patients with cSAH associated with probable or possible CAA diagnosed on baseline MRI using the modified Boston criteria. We used Cox proportional hazards models with a frailty term to account for between-cohort differences. Results We included 190 patients (mean age 74.5 years; 45.3% female) from 13 centers with 385 patient-years of follow-up (median 1.4 years). The risks of each outcome (per patient-year) were: ICH 13.2% (95% CI 9.9-17.4); recurrent cSAH 11.1% (95% CI 7.9-15.2); combined ICH, cSAH, or both 21.4% (95% CI 16.7-26.9), ischemic stroke 5.1% (95% CI 3.1-8) and death 8.3% (95% CI 5.6-11.8). In multivariable models, there is evidence that patients with probable CAA (compared to possible CAA) had a higher risk of ICH (HR 8.45, 95% CI 1.13-75.5, p = 0.02) and cSAH (HR 3.66, 95% CI 0.84-15.9, p = 0.08) but not ischemic stroke (HR 0.56, 95% CI 0.17-1.82, p = 0.33) or mortality (HR 0.54, 95% CI 0.16-1.78, p = 0.31). Conclusions Patients with cSAH associated with probable or possible CAA have high risk of future ICH and recurrent cSAH. Convexity SAH associated with probable (vs possible) CAA is associated with increased risk of ICH, and cSAH but not ischemic stroke. Our data provide precise risk estimates for key vascular events after cSAH associated with CAA which can inform management decisions.

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