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

• Authors: Daniel Refai, Emory University; Isabel Charlotte Hostettler, University College London; Duncan Wilson, University College London; Catherine Arnold Fiebelkorn, Mayo Clinic; Diane Aum, Washington University; Sebastián Francisco Ameriso, Institute for Neurological Research; Federico Eberbach, Institute for Neurological Research; Markus Beitzke, Medical University of Graz; Timothy Kleinig, Royal Adelaide Hospital; Thanh Phan, Monash Hlth & Stroke & Ageing Res Grp; Sarah Marchina, Harvard Medical School; Romain Schneckenburger, CHU Caen Normandie; Maria Carmona-Iragui, Universitat Autònoma de Barcelona; Andreas Charidimou, Massachusetts General Hospital; Isabelle Mourand, CHU de Montpellier,; Sara Parreira, Univ Lisbon; Gareth Ambler, University College London; Hans R Jager, University College London; Shaloo Singhal, Monash Health and Stroke and Ageing Research Group; John Ly, Monash Health and Stroke and Ageing Research Group; Henry Ma, Monash Health and Stroke and Ageing Research Group; Emmanuel Touzé, Normandy University; Ruth Geraldes, Oxford University Hospitals; Ana Catarina Fonseca, University of Lisbon; Teresa Melo, University of Lisbon; Pierre Labauge, CHU de Montpellier; Pierre-Henry Lefevre, CHU de Montpellier; Anand Viswanathan, Massachusetts General Hospital; Steven Mark Greenberg, Massachusetts General Hospital; Juan Fortea, Universitat Autònoma de Barcelona; Marion Apoil, CHU Caen Normandie; Marion Boulanger, CHU Caen Normandie; Fausto Viader, CHU Caen Normandie; Sandeep Kumar, Harvard Medical School; Velandai Srikanth, OpenEmory _ Risk of intracranial haemorrhage and ischaemic stroke after convexity subarachnoid haemorrhage in cerebral amyloid angiopathy_ international individual patient data pooled analysis _ Edit; Ashan Khurram, Royal Adelaide Hospital; Franz Fazekas, Medical University of Graz; Veronica Bruno, Institute for Neurological Research; Gregory J Zipfel, Washington University; Alejandro Rabinstein, Mayo Clinic; Jonathan Graff-Radford, Mayo Clinic; David John Werring, University College London
• Journal Title: JOURNAL OF NEUROLOGY
• Volume: Volume 269, Number 3
• Publisher: SPRINGER HEIDELBERG | 2021-07-17, Pages 1427-1438
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1007/s00415-021-10706-3
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Clinical Neurology; Neurosciences & Neurology; Non-traumatic convexity; convexal; cortical subarachnoid haemorrhage; Intracerebral haemorrhage; Ischemic stroke; Cerebral amyloid angiopathy; Stroke; RECURRENT INTRACEREBRAL HEMORRHAGE; SUPERFICIAL SIDEROSIS; CLINICAL PRESENTATION; IMAGING PATTERNS; FEATURES

Abstract

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.