Risk of intracranial haemorrhage and ischaemic stroke after convexity subarachnoid haemorrhage in cerebral amyloid angiopathy : international individual patient data pooled analysis
Hostettler, Isabel Charlotte (University College London)
Wilson, Duncan (University College London)
Fiebelkorn, Catherine Arnold (Mayo Clinic)
Aum, Diane (Washington University School of Medicine)
Ameriso, Sebastián Francisco (Institute for Neurological Research)
Eberbach, Federico (Institute for Neurological Research)
Beitzke, Markus (Medical University of Graz)
Kleinig, Timothy (Royal Adelaide Hospital)
Phan, Thanh (Monash University)
Marchina, Sarah (Beth Israel Deaconess Medical Center)
Schneckenburger, Romain (CHU Caen Normandie)
Carmona Iragui, María (Institut d'Investigació Biomèdica Sant Pau)
Charidimou, Andreas (Massachusetts General Hospital (Boston))
Mourand, Isabelle (Hôpital Gui-de-Chauliac)
Parreira, Sara (University of Lisbon)
Ambler, Gareth (UCL. Department of Statistical Science)
Jäger, Hans Rolf (University College London)
Singhal, Shaloo (Monash University)
Ly, John (Monash University)
Ma, Henry (Monash University)
Touzé, Emmanuel (Normandy University)
Geraldes, Ruth (Frimley Health Foundation Trust)
Fonseca, Ana Catarina (University of Lisbon)
Melo, Teresa (Hospital de Santa Maria, University of Lisbon)
Labauge, Pierre (Hôpital Gui-de-Chauliac)
Lefèvre, Pierre-Henry (Hôpital Gui-de-Chauliac)
Viswanathan, Anand (Harvard Medical School)
Greenberg, Steven Mark (Massachusetts General Hospital (Boston))
Fortea, Juan (Institut d'Investigació Biomèdica Sant Pau)
Apoil, Marion (CHU Caen Normandie)
Boulanger, Marion (Normandy University)
Viader, Fausto (CHU Caen Normandie)
Kumar, Sandeep (Beth Israel Deaconess Medical Center)
Srikanth, Velandai (Monash University)
Khurram, Ashan (Royal Adelaide Hospital)
Fazekas, Franz (Medical University of Graz)
Bruno, Veronica (Institute for Neurological Research)
Zipfel, Gregory Joseph (Washington University School of Medicine)
Refai, Daniel (Emory University)
Rabinstein, Alejandro (Mayo Clinic)
Graff-Radford, Jonathan (Mayo Clinic)
Werring, David John (University College London)
Universitat Autònoma de Barcelona

Fecha:	2021
Resumen:	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). 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. 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). 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. The online version contains supplementary material available at 10. 1007/s00415-021-10706-3.
Nota:	Altres ajuts: JF reports grants from Instituto de Salud Carlos III, grants from Fundació Marató TV3, grants from NIH, grants from Departament de Salut de la Generalitat de Catalunya.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article de revisió ; recerca ; Versió publicada
Materia:	Non-traumatic convexity/convexal/cortical subarachnoid haemorrhage ; Intracerebral haemorrhage ; Ischemic stroke ; Cerebral amyloid angiopathy ; Stroke
Publicado en:	Journal of Neurology, Vol. 269 (july 2021) , p. 1427-1438, ISSN 1432-1459

DOI: 10.1007/s00415-021-10706-3
PMID: 34272978

12 p, 1.5 MB

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