Cortical superficial siderosis and recurrent intracerebral hemorrhage risk in cerebral amyloid angiopathy: Large prospective cohort and preliminary meta-analysis

被引：47
作者：
Charidimou, Andreas [1 ]
Boulouis, Gregoire [1 ]
Roongpiboonsopit, Duangnapa [1 ,2 ]
Xiong, Li [1 ]
Pasi, Marco [1 ]
Schwab, Kristin M. [1 ]
Rosand, Jonathan [1 ,3 ]
Gurol, M. Edip [1 ]
Greenberg, Steven M. [1 ]
Viswanathan, Anand [1 ]
机构：
[1] Harvard Med Sch, Massachusetts Gen Hosp, Hemorrhag Stroke Res Program, Dept Neurol,JPK Stroke Res Ctr, 175 Cambridge St,Suite 300, Boston, MA 02114 USA
[2] Naresuan Univ, Fac Med, Dept Med, Div Neurol, Phitsanulok, Thailand
[3] Harvard Med Sch, Massachusetts Gen Hosp, Div Neurocrit Care & Emergency Neurol, Boston, MA 02114 USA
来源：
INTERNATIONAL JOURNAL OF STROKE | 2019年 / 14卷 / 07期
关键词：
Intracerebral hemorrhage; MRI; cerebral amyloid angiopathy; cerebral small vessel disease; cortical superficial siderosis; SMALL VESSEL DISEASE; MICROBLEEDS; PREVALENCE; PHENOTYPES; TRIALS;
D O I：
10.1177/1747493019830065
中图分类号：
R74 [神经病学与精神病学];
学科分类号：
摘要：
Background We aimed to investigate cortical superficial siderosis as an MRI predictor of lobar intracerebral hemorrhage (ICH) recurrence risk in cerebral amyloid angiopathy (CAA), in a large prospective MRI cohort and a systematic review. Methods We analyzed a single-center MRI prospective cohort of consecutive CAA-related ICH survivors. Using Kaplan-Meier and Cox regression analyses, we investigated cortical superficial siderosis and ICH risk, adjusting for known confounders. We pooled data with eligible published cohorts in a two-stage meta-analysis using random effects models. Covariate-adjusted hazard rations (adj-HR) from pre-specified multivariable Cox proportional hazard models were used. Results The cohort included 240 CAA-ICH survivors (cortical superficial siderosis prevalence: 36%). During a median follow-up of 2.6 years (IQR: 0.9-5.1 years) recurrent ICH occurred in 58 patients (24%). In prespecified multivariable Cox regression models, cortical superficial siderosis presence and disseminated cortical superficial siderosis were independent predictors of increased symptomatic ICH risk at follow-up (HR: 2.26; 95% CI: 1.31-3.87, p = 0.003 and HR: 3.59; 95% CI: 1.96-6.57, p < 0.0001, respectively). Three cohorts including 443 CAA-ICH patients in total were eligible for meta-analysis. During a mean follow-up of 2.5 years (range: 2-3 years) 92 patients experienced recurrent ICH (pooled risk ratio: 6.9% per year, 95% CI: 4.2%-9.7% per year). In adjusted pooled analysis, any cortical superficial siderosis and disseminated cortical superficial siderosis were the only independent predictors associated with increased lobar ICH recurrence risk (adj-HR: 2.4; 95% CI: 1.5-3.7; p < 0.0001, and adj-HR: 4.4; 95% CI: 2-9.9; p < 0.0001, respectively). Conclusions In CAA-ICH patients, cortical superficial siderosis presence and extent are the most important MRI prognostic risk factors for lobar ICH recurrence. These results can help guide clinical decision making in patients with CAA.
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页码：723 / 733
页数：11
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