Severe pathological manifestation of cerebral amyloid angiopathy correlates with poor outcome from cerebral amyloid angiopathy related intracranial hemorrhage

Background Cerebral amyloid angiopathy (CAA) is one of the main causes of spontaneous intracranial hemorrhage (ICH). No established link is available between pathological scores of CAA and its outcome. This study aimed to identify the correlations between pathological severity and poor postoperative outcome in the Chinese population. Methods Between May 2006 and April 2011, 367 consecutive patients who underwent surgery for CAA-related ICH in 71 hospitals throughout the mainland of China were enrolled in this study. Twelve months after surgery, we evaluated these patients' outcomes according to the modified Rankin Scale (mRS) and statistically correlated risk factors (demographics, medical history, pathological results, and surgical details) that are associated with a favorable (mRS <3) and poor (mRS 3) outcome groups. Results Risk factors for poor postoperative outcome in 367 patients with CAA-related ICH included advanced age (OR 1.034, 95% CI 1.001-1.067, P=0.042), CAA pathology severity (OR 2.074, 95% CI 7.140-16.25, P <0.001), lobar hematoma (OR 0.225, 95% CI 0.104-0.486, P <0.001), presence of intraventricular hemorrhage (OR 0.478, 95% CI 0.229-1.001, P=0.050), and/or subarachnoid hemorrhage (OR 2.629, 95% CI, 1.051-6.577, P=0.039). Conclusions Poor postoperative outcome of patients with CAA-related ICH was more related to the severe pathological manifestation instead of other factors. Prior ischemia may present an early stage of CAA.