Santosh B Murthy1, Cenai Zhang1, Ajay Gupta2, Sung-Min Cho3, Lucia Rivera-Lara3, Radhika Avadhani4, Joshua Gruber4, Costantino Iadecola1, Guido J Falcone5, Kevin N Sheth5, Adnan I Qureshi6, Joshua N Goldstein7, Daniel F Hanley4, Hooman Kamel1, Wendy C Ziai3. 1. Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology (S.B.M., C.Z., C.I., H.K.), Weill Cornell Medicine, New York, NY. 2. Department of Radiology (A.G.), Weill Cornell Medicine, New York, NY. 3. Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD (S.-M.C., L.R.-L., W.C.Z.). 4. Brain Injury Outcomes Center, Johns Hopkins University, Baltimore, MD (R.A., J.G., D.F.H.). 5. Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (G.J.F., K.N.S.). 6. Zeenat Qureshi Stroke Institutes and Department of Neurology, University of Missouri, Columbia (A.I.Q.). 7. Department of Emergency Medicine, Massachusetts General Hospital, Boston (J.N.G.).
Abstract
BACKGROUND AND PURPOSE: Punctate ischemic lesions noted on diffusion-weighted imaging (DWI) are associated with poor functional outcomes after intracerebral hemorrhage (ICH). Whether these lesions increase long-term risk of stroke is poorly understood. METHODS: We pooled individual patient data from the ATACH-2 trial (Antihypertensive Treatment of Acute Cerebral Hemorrhage) and the MISTIE III trial (Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation Phase 3). We included subjects with a magnetic resonance imaging scan. The exposure was a DWI lesion. The primary outcome was any stroke, defined as a composite of ischemic stroke or recurrent ICH, whereas secondary outcomes were incident ischemic stroke and recurrent ICH. Using multivariate Cox regression analysis, we evaluated the risk of stroke. RESULTS: Of 505 patients with ICH with magnetic resonance imaging, 466 were included. DWI lesions were noted in 214 (45.9%) subjects, and 34 incident strokes (20 ischemic stroke and 14 recurrent ICH) were observed during a median follow-up of 324 days (interquartile range, 91-374). Presence of a DWI lesion was associated with a 6.9% (95% CI, 2.2-11.6) absolute increase in risk of all stroke (hazard ratio, 2.6 [95% CI, 1.2-5.7]). Covariate adjustment with Cox regression models also demonstrated this increased risk. In the secondary analyses, there was an increased risk of ischemic stroke (hazard ratio, 3.5 [95% CI, 1.1-11.0]) but not recurrent ICH (hazard ratio, 1.7 [95% CI, 0.6-5.1]). CONCLUSIONS: In a heterogeneous cohort of patients with ICH, presence of a DWI lesion was associated with a 2.5-fold heightened risk of stroke among ICH survivors. This elevated risk persisted for ischemic stroke but not for recurrent ICH.
BACKGROUND AND PURPOSE: Punctate ischemic lesions noted on diffusion-weighted imaging (DWI) are associated with poor functional outcomes after intracerebral hemorrhage (ICH). Whether these lesions increase long-term risk of stroke is poorly understood. METHODS: We pooled individual patient data from the ATACH-2 trial (Antihypertensive Treatment of Acute Cerebral Hemorrhage) and the MISTIE III trial (Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation Phase 3). We included subjects with a magnetic resonance imaging scan. The exposure was a DWI lesion. The primary outcome was any stroke, defined as a composite of ischemic stroke or recurrent ICH, whereas secondary outcomes were incident ischemic stroke and recurrent ICH. Using multivariate Cox regression analysis, we evaluated the risk of stroke. RESULTS: Of 505 patients with ICH with magnetic resonance imaging, 466 were included. DWI lesions were noted in 214 (45.9%) subjects, and 34 incident strokes (20 ischemic stroke and 14 recurrent ICH) were observed during a median follow-up of 324 days (interquartile range, 91-374). Presence of a DWI lesion was associated with a 6.9% (95% CI, 2.2-11.6) absolute increase in risk of all stroke (hazard ratio, 2.6 [95% CI, 1.2-5.7]). Covariate adjustment with Cox regression models also demonstrated this increased risk. In the secondary analyses, there was an increased risk of ischemic stroke (hazard ratio, 3.5 [95% CI, 1.1-11.0]) but not recurrent ICH (hazard ratio, 1.7 [95% CI, 0.6-5.1]). CONCLUSIONS: In a heterogeneous cohort of patients with ICH, presence of a DWI lesion was associated with a 2.5-fold heightened risk of stroke among ICH survivors. This elevated risk persisted for ischemic stroke but not for recurrent ICH.
Entities:
Keywords:
cerebral hemorrhage; hematoma; hypertension; magnetic resonance imaging; risk
Authors: Adnan I Qureshi; Yuko Y Palesch; William G Barsan; Daniel F Hanley; Chung Y Hsu; Renee L Martin; Claudia S Moy; Robert Silbergleit; Thorsten Steiner; Jose I Suarez; Kazunori Toyoda; Yongjun Wang; Haruko Yamamoto; Byung-Woo Yoon Journal: N Engl J Med Date: 2016-06-08 Impact factor: 91.245
Authors: Ravi S Menon; Richard E Burgess; Jeffrey J Wing; M Christopher Gibbons; Nawar M Shara; Stephen Fernandez; Annapurni Jayam-Trouth; Laura German; Ian Sobotka; Dorothy Edwards; Chelsea S Kidwell Journal: Ann Neurol Date: 2012-02 Impact factor: 10.422
Authors: Rajeev K Garg; Storm M Liebling; Matthew B Maas; Alexander J Nemeth; Eric J Russell; Andrew M Naidech Journal: Stroke Date: 2011-10-06 Impact factor: 7.914
Authors: Jamary Oliveira-Filho; Hakan Ay; Ashkan Shoamanesh; Kwang Yeol Park; Ross Avery; Mine Sorgun; Gyeong-Moon Kim; Pedro T Cougo; Steven M Greenberg; M Edip Gurol Journal: J Neuroimaging Date: 2018-04-01 Impact factor: 2.486
Authors: Chelsea S Kidwell; Jonathan Rosand; Gina Norato; Simone Dixon; Bradford B Worrall; Michael L James; Mitchell S V Elkind; Matthew L Flaherty; Jennifer Osborne; Anastasia Vashkevich; Carl D Langefeld; Charles J Moomaw; Daniel Woo Journal: Neurology Date: 2017-01-25 Impact factor: 9.910
Authors: Rustam Al-Shahi Salman; David P Minks; Dipayan Mitra; Mark A Rodrigues; Priya Bhatnagar; Johann C du Plessis; Yogish Joshi; Martin S Dennis; Gordon D Murray; David E Newby; Peter A G Sandercock; Nikola Sprigg; Jacqueline Stephen; Cathie L M Sudlow; David J Werring; William N Whiteley; Joanna M Wardlaw; Philip M White Journal: Lancet Neurol Date: 2019-05-22 Impact factor: 59.935