Hemorrhage recurrence risk factors in cerebral amyloid angiopathy: Comparative analysis of the overall small vessel disease severity score versus individual neuroimaging markers

被引：43

作者：

Boulouis, Gregoire ^{[1
]}

Charidimou, Andreas ^{[1
]}

Pasi, Marco ^{[1
]}

Roongpiboonsopit, Duangnapa ^{[1
,2
]}

Xiong, Li ^{[1
]}

Auriel, Eitan ^{[1
]}

van Etten, Ellis S. ^{[1
,3
]}

Martinez-Ramirez, Sergi ^{[1
]}

Ayres, Alison ^{[1
]}

Vashkevich, Anastasia ^{[1
]}

Schwab, Kristin M. ^{[1
]}

Rosand, Jonathan ^{[1
,4
]}

Goldstein, Joshua N. ^{[1
,4
]}

Gurol, M. Edip ^{[1
]}

Greenberg, Steven M. ^{[1
]}

Viswanathan, Anand ^{[1
]}

机构：

[1] Harvard Med Sch, Massachusetts Gen Hosp, Dept Neurol, Hemorrhag Stroke Res Program,Stroke Res Ctr, Boston, MA USA

[2] Naresuan Univ, Dept Med, Fac Med, Phitsanulok, Thailand

[3] Leiden Univ, Dept Neurol, Med Ctr, Leiden, Netherlands

[4] Harvard Med Sch, Massachusetts Gen Hosp, Div Neurocrit Care & Emergency Neurol, Boston, MA USA

来源：

JOURNAL OF THE NEUROLOGICAL SCIENCES | 2017年 / 380卷

关键词：

Intracerebral hemorrhage; MRI; All cerebrovascular disease/stroke; Cerebral amyloid angiopathy; Cerebral small vessel disease; INTRACEREBRAL HEMORRHAGE; SUPERFICIAL SIDEROSIS; PERIVASCULAR SPACES; BURDEN; MRI;

D O I：

10.1016/j.jns.2017.07.015

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Introduction: An MRI-based score of total small vessel disease burden (CAA-SVD-Score) in cerebral amyloid angiopathy (CAA) has been demonstrated to correlate with severity of pathologic changes. Evidence suggests that CAA-related intracerebral hemorrhage (ICH) recurrence risk is associated with specific disease imaging manifestations rather than overall severity. We compared the correlation between the CAA-SVD-Score with the risk of recurrent CAA-related lobar ICH versus the predictive role of each of its components. Methods: Consecutive patients with CAA-related ICH from a single-center prospective cohort were analyzed. Radiological markers of CAA related SVD damage were quantified and categorized according to the CAA-SVD-Score (0-6 points). Subjects were followed prospectively for recurrent symptomatic ICH. Adjusted Cox proportional hazards models were used to investigate associations between the CM-SVD-Score as well as each of the individual MRI signatures of CAA and the risk of recurrent ICH. Results: In 229 CAA patients with ICH, a total of 56 recurrent ICH events occurred during a median follow-up of 2.8 years [IQR 0.9-5.4 years, 781 person-years). Higher CAA-SVD-Score (HR = 1.26 per additional point, 95%CI [1.04-1.52], p = 0.015) and older age were independently associated with higher ICH recurrence risk. Analysis of individual markers of CAA showed that CAA-SVD-Score findings were due to the independent effect of disseminated superficial siderosis (HR for disseminated cSS vs none: 2.89, 95%Cl [1.47-5.5], p = 0.002) and high degree of perivascular spaces enlargement (RR = 3.50-95%CI [1.04-21], p = 0.042). Conclusion: In lobar CAA-ICH patients, higher CAA-SVD-Score does predict recurrent ICH. Amongst individual elements of the score, superficial siderosis and dilated perivascular spaces are the only markers independently associated with ICH recurrence, contributing to the evidence for distinct CAA phenotypes singled out by neuro-imaging manifestations. (C) 2017 Elsevier B.V. All rights reserved.

引用

页码：64 / 67

页数：4

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