Risk of intracranial haemorrhage and ischaemic stroke after convexity subarachnoid haemorrhage in cerebral amyloid angiopathy: international individual patient data pooled analysis
Por:
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
Publicada:
1 mar 2022
Ahead of Print:
1 jul 2021
Resumen:
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.
Filiaciones:
Hostettler, IC:
UCL, Inst Neurol, Natl Hosp Neurol & Neurosurg, Ctr Stroke Res, Queen Sq, London WC1N, England
Wilson, D:
UCL, Inst Neurol, Natl Hosp Neurol & Neurosurg, Ctr Stroke Res, Queen Sq, London WC1N, England
Fiebelkorn, CA:
Mayo Clin, Dept Neurol, Rochester, MN USA
Aum, D:
Washington Univ, Dept Neurol Surg, Sch Med, St Louis, MO USA
Ameriso, SF:
Neurol Res Inst, Fleni, Buenos Aires, DF, Argentina
Eberbach, F:
Neurol Res Inst, Fleni, Buenos Aires, DF, Argentina
Beitzke, M:
Med Univ Graz, Dept Neurol, Graz, Austria
Kleinig, T:
Royal Adelaide Hosp, Dept Neurol, Adelaide, SA, Australia
Phan, T:
Monash Hlth & Stroke & Ageing Res Grp, Dept Neurol, Melbourne, Australia
Monash Univ, Sch Clin Sci, Dept Med, Melbourne, Australia
Marchina, S:
Harvard Med Sch, Stroke Div, Dept Neurol, Beth Israel Deaconess Med Ctr, Boston, MA USA
Schneckenburger, R:
CHU Caen Normandie, Dept Neurol, Caen, France
Carmona-Iragui, M:
Univ Autonoma Barcelona, Inst Invest Biomed Sant Pau, Hosp Santa Creu Sant Pau, Dept Neurol, Barcelona, Spain
Charidimou, A:
Massachusetts Gen Hosp, Dept Neurol, J Philip Kistler Stroke Res Ctr, Boston, MA USA
Harvard Med Sch, Boston, MA USA
Mourand, I:
CHU Montpellier, Dept Neurol, Hop Gui Chauliac, Montpellier, France
Parreira, S:
Univ Lisbon, Hosp Santa Maria, Dept Neurosci, Stroke Unit, Lisbon, Portugal
Ambler, G:
UCL, Dept Stat Sci, London WC1E 6BT, England
Jager, HR:
UCL, Neuroradiol Acad Unit, Inst Neurol, Dept Brain Repair Rehabil, London, England
Singhal, S:
Monash Hlth & Stroke & Ageing Res Grp, Dept Neurol, Melbourne, Australia
Monash Univ, Sch Clin Sci, Dept Med, Melbourne, Australia
Ly, J:
Monash Hlth & Stroke & Ageing Res Grp, Dept Neurol, Melbourne, Australia
Monash Univ, Sch Clin Sci, Dept Med, Melbourne, Australia
Ma, H:
Monash Hlth & Stroke & Ageing Res Grp, Dept Neurol, Melbourne, Australia
Monash Univ, Sch Clin Sci, Dept Med, Melbourne, Australia
Touze, E:
Normandy Univ, UNICAEN, INSERM, Caen, France
Geraldes, R:
Oxford Univ Hosp, Nuffield Dept Clin Neurosci, Oxford, England
Frimley Hlth Fdn Trust, Dept Neurol, Camberley, England
Fonseca, AC:
Univ Lisbon, Hosp Santa Maria, Dept Neurosci, Stroke Unit, Lisbon, Portugal
Melo, T:
Univ Lisbon, Hosp Santa Maria, Dept Neurosci, Stroke Unit, Lisbon, Portugal
Labauge, P:
CHU Montpellier, Dept Neurol, Hop Gui Chauliac, Montpellier, France
Lefevre, PH:
CHU Montpellier, Dept Neuroradiol, Hop Gui Chauliac, Montpellier, France
Viswanathan, A:
Massachusetts Gen Hosp, Dept Neurol, J Philip Kistler Stroke Res Ctr, Boston, MA USA
Harvard Med Sch, Boston, MA USA
Greenberg, SM:
Massachusetts Gen Hosp, Dept Neurol, J Philip Kistler Stroke Res Ctr, Boston, MA USA
Harvard Med Sch, Boston, MA USA
Fortea, J:
Univ Autonoma Barcelona, Inst Invest Biomed Sant Pau, Hosp Santa Creu Sant Pau, Dept Neurol, Barcelona, Spain
Apoil, M:
CHU Caen Normandie, Dept Neurol, Caen, France
Boulanger, M:
CHU Caen Normandie, Dept Neurol, Caen, France
Viader, F:
CHU Caen Normandie, Dept Neurol, Caen, France
Kumar, S:
Harvard Med Sch, Stroke Div, Dept Neurol, Beth Israel Deaconess Med Ctr, Boston, MA USA
Srikanth, V:
Monash Hlth & Stroke & Ageing Res Grp, Dept Neurol, Melbourne, Australia
Monash Univ, Sch Clin Sci, Dept Med, Melbourne, Australia
Khurram, A:
Royal Adelaide Hosp, Dept Neurol, Adelaide, SA, Australia
Fazekas, F:
Med Univ Graz, Dept Neurol, Graz, Austria
Bruno, V:
Neurol Res Inst, Fleni, Buenos Aires, DF, Argentina
Zipfel, GJ:
Washington Univ, Dept Neurol Surg, Sch Med, St Louis, MO USA
Refai, D:
Emory Univ, Dept Neurosurg, Atlanta, GA USA
Rabinstein, A:
Mayo Clin, Dept Neurol, Rochester, MN USA
Graff-Radford, J:
Mayo Clin, Dept Neurol, Rochester, MN USA
Werring, DJ:
UCL, Inst Neurol, Natl Hosp Neurol & Neurosurg, Ctr Stroke Res, Queen Sq, London WC1N, England
Green Published, hybrid
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