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

Aged Brain Ischemia / complications Cerebral Amyloid Angiopathy / complications Cerebral Hemorrhage / complications Female Humans Ischemic Stroke Magnetic Resonance Imaging Male Stroke / complications Subarachnoid Hemorrhage / complications
Cerebral amyloid angiopathy Intracerebral haemorrhage Ischemic stroke Non-traumatic convexity/convexal/cortical subarachnoid haemorrhage Stroke

Journal

Journal of neurology
ISSN: 1432-1459
Titre abrégé: J Neurol
Pays: Germany
ID NLM: 0423161

Informations de publication

Date de publication:
Mar 2022
Historique:
received: 22 05 2021
accepted: 09 07 2021
revised: 06 07 2021
pubmed: 18 7 2021
medline: 23 2 2022
entrez: 17 7 2021
Statut: ppublish

Résumé

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). 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. 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). 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.

Identifiants

DOI: 10.1007/s00415-021-10706-3 PMID: 34272978 PMC: PMC8857171
pubmed: 34272978
doi: 10.1007/s00415-021-10706-3
pii: 10.1007/s00415-021-10706-3
pmc: PMC8857171
doi:

Types de publication

Journal Article Systematic Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

1427-1438

Informations de copyright

© 2021. The Author(s).

Références

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Auteurs

Isabel Charlotte Hostettler (IC)

Stroke Research Centre, University College London, National Hospital of Neurology and Neurosurgery, Institute of Neurology, Queen Square, London, WC1N, UK.
ORCID: 0000-0002-9004-2540

Duncan Wilson (D)

Stroke Research Centre, University College London, National Hospital of Neurology and Neurosurgery, Institute of Neurology, Queen Square, London, WC1N, UK.

Catherine Arnold Fiebelkorn (CA)

Department of Neurology, Mayo Clinic, Rochester, MN, USA.

Diane Aum (D)

Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA.

Sebastián Francisco Ameriso (SF)

Institute for Neurological Research, Fleni, Buenos Aires, Argentina.

Federico Eberbach (F)

Institute for Neurological Research, Fleni, Buenos Aires, Argentina.

Markus Beitzke (M)

Department of Neurology, Medical University of Graz, Graz, Austria.

Timothy Kleinig (T)

Department of Neurology, Royal Adelaide Hospital, Adelaide, Australia.
ORCID: 0000-0003-4430-3276

Thanh Phan (T)

Department of Neurology, Monash Health and Stroke and Ageing Research Group, Melbourne, Australia.
Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia.
ORCID: 0000-0003-3400-6323

Sarah Marchina (S)

Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

Romain Schneckenburger (R)

Department of Neurology, CHU Caen Normandie, Caen, France.

Maria Carmona-Iragui (M)

Memory Unit, Department of Neurology, Hospital de la Santa Creu I Sant Pau, Institut Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
ORCID: 0000-0001-6914-2339

Andreas Charidimou (A)

J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.

Isabelle Mourand (I)

Department of Neurology, CHU de Montpellier, Hôpital Gui-de-Chauliac, Montpellier, France.

Sara Parreira (S)

Stroke Unit, Department of Neuroscience, Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal.

Gareth Ambler (G)

Department of Statistical Science, UCL, London, WC1E 6BT, UK.

Hans Rolf Jäger (HR)

Neuroradiological Academic Unit, Department of Brain Repair & Rehabilitation, University College London, Institute of Neurology, London, UK.

Shaloo Singhal (S)

Department of Neurology, Monash Health and Stroke and Ageing Research Group, Melbourne, Australia.
Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia.

John Ly (J)

Department of Neurology, Monash Health and Stroke and Ageing Research Group, Melbourne, Australia.
Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia.

Henry Ma (H)

Department of Neurology, Monash Health and Stroke and Ageing Research Group, Melbourne, Australia.
Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia.

Emmanuel Touzé (E)

Normandy University, UNICAEN, INSERM U1237, Caen, France.

Ruth Geraldes (R)

Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK.
Neurology department, Frimley Health Foundation Trust, Camberley, UK.
ORCID: 0000-0001-5829-808X

Ana Catarina Fonseca (AC)

Stroke Unit, Department of Neuroscience, Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal.
ORCID: 0000-0001-6913-5526

Teresa Melo (T)

Stroke Unit, Department of Neuroscience, Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal.

Pierre Labauge (P)

Department of Neurology, CHU de Montpellier, Hôpital Gui-de-Chauliac, Montpellier, France.

Pierre-Henry Lefèvre (PH)

Department of Neuroradiology, CHU de Montpellier, Hôpital Gui-de-Chauliac, Montpellier, France.

Anand Viswanathan (A)

J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.

Steven Mark Greenberg (SM)

J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.

Juan Fortea (J)

Memory Unit, Department of Neurology, Hospital de la Santa Creu I Sant Pau, Institut Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
ORCID: 0000-0002-1340-638X

Marion Apoil (M)

Department of Neurology, CHU Caen Normandie, Caen, France.

Marion Boulanger (M)

Department of Neurology, CHU Caen Normandie, Caen, France.
Normandy University, UNICAEN, INSERM U1237, Caen, France.

Fausto Viader (F)

Department of Neurology, CHU Caen Normandie, Caen, France.

Sandeep Kumar (S)

Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

Velandai Srikanth (V)

Department of Neurology, Monash Health and Stroke and Ageing Research Group, Melbourne, Australia.
Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia.

Ashan Khurram (A)

Department of Neurology, Royal Adelaide Hospital, Adelaide, Australia.

Franz Fazekas (F)

Department of Neurology, Medical University of Graz, Graz, Austria.
ORCID: 0000-0001-8155-7799

Veronica Bruno (V)

Institute for Neurological Research, Fleni, Buenos Aires, Argentina.

Gregory Joseph Zipfel (GJ)

Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA.

Daniel Refai (D)

Department of Neurosurgery, Emory University, Atlanta, GA, USA.

Alejandro Rabinstein (A)

Department of Neurology, Mayo Clinic, Rochester, MN, USA.

Jonathan Graff-Radford (J)

Department of Neurology, Mayo Clinic, Rochester, MN, USA.

David John Werring (DJ)

Stroke Research Centre, University College London, National Hospital of Neurology and Neurosurgery, Institute of Neurology, Queen Square, London, WC1N, UK. d.werring@ucl.ac.uk.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Risk of intracranial haemorrhage and ischaemic...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Angiopathies intracrâniennes › Encéphalopathie ischémique › Risk of intracranial haemorrhage and ischaemic...
questionsmedicales.fr › Maladies métaboliques et nutritionnelles › Maladies métaboliques › Troubles de l'homéostasie des protéines › Amyloïdose › Angiopathie amyloïde cérébrale › Risk of intracranial haemorrhage and ischaemic...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Hémorragie › Hémorragies intracrâniennes › Hémorragie cérébrale › Risk of intracranial haemorrhage and ischaemic...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Risk of intracranial haemorrhage and ischaemic...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Angiopathies intracrâniennes › Accident vasculaire cérébral › Accident vasculaire cérébral ischémique › Risk of intracranial haemorrhage and ischaemic...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Imagerie diagnostique › Tomographie › Imagerie par résonance magnétique › Risk of intracranial haemorrhage and ischaemic...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Angiopathies intracrâniennes › Accident vasculaire cérébral › Risk of intracranial haemorrhage and ischaemic...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Hémorragie › Hémorragies intracrâniennes › Hémorragie meningée › Risk of intracranial haemorrhage and ischaemic...