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Cerebral Amyloid Angiopathy and the Risk of Hematoma Expansion

Seiffge DJ 1 , Polymeris AA 2 , Law ZK 3 , Krishnan K 3 , Zietz A 2 , Thilemann S 2 Show all authors , Werring D 4 , Al-Shahi Salman R 5 , Dineen RA 6 , Engelter ST 2 , Bath PM 3 , Sprigg N 3 , Lyrer P 2 , Peters N 2 , TICH-2 Investigators

Affiliations 

  • 1 Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland
  • 2 Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
  • 3 Stroke Trials Unit, University of Nottingham, Nottingham, UK
  • 4 Stroke Research Centre, University College London Queen Square Institute of Neurology, London, UK
  • 5 Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
  • 6 Radiological Sciences, University of Nottingham, Nottingham, UK
Ann Neurol, 2022 Dec;92(6):921-930.
PMID: 36054211 DOI: 10.1002/ana.26481

Abstract

OBJECTIVE: We assessed whether hematoma expansion (HE) and favorable outcome differ according to type of intracerebral hemorrhage (ICH).

METHODS: Among participants with ICH enrolled in the TICH-2 (Tranexamic Acid for Hyperacute Primary Intracerebral Haemorrhage) trial, we assessed baseline scans for hematoma location and presence of cerebral amyloid angiopathy (CAA) using computed tomography (CT, simplified Edinburgh criteria) and magnetic resonance imaging (MRI; Boston criteria) and categorized ICH as lobar CAA, lobar non-CAA, and nonlobar. The main outcomes were HE and favorable functional outcome. We constructed multivariate regression models and assessed treatment effects using interaction terms.

RESULTS: A total of 2,298 out of 2,325 participants were included with available CT (98.8%; median age = 71 years, interquartile range = 60-80 years; 1,014 female). Additional MRI was available in 219 patients (9.5%). Overall, 1,637 participants (71.2%) had nonlobar ICH; the remaining 661 participants (28.8%) had lobar ICH, of whom 202 patients had lobar CAA-ICH (8.8%, 173 participants according to Edinburgh and 29 participants according to Boston criteria) and 459 did not (lobar non-CAA, 20.0%). For HE, we found a significant interaction of lobar CAA ICH with time from onset to randomization (increasing risk with time, pinteraction  

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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