Diffusion-Weighted Imaging Lesions After Intracerebral Hemorrhage and Risk of Stroke: A MISTIE III and ATACH-2 Analysis.

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.

• Authors: Santosh B Murthy, Cenai Zhang, Ajay Gupta, Sung-Min Cho, Lucia Rivera-Lara, Radhika Avadhani, Joshua Gruber, Costantino Iadecola, Guido J Falcone, Kevin N Sheth, Adnan I Qureshi, Joshua N Goldstein, Daniel F Hanley, Hooman Kamel, Wendy C Ziai
• Journal: Stroke (Stroke) Vol. 52 Issue 2 Pg. 595-602 (01 2021) ISSN: 1524-4628 [Electronic] United States
• PMID: 33467877 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural)

Chemical References

• Antihypertensive Agents

Topics

• Adult
• Aged
• Aged, 80 and over
• Antihypertensive Agents (therapeutic use)
• Cerebral Hemorrhage (complications, diagnostic imaging, therapy)
• Cohort Studies
• Diffusion Magnetic Resonance Imaging (methods)
• Female
• Follow-Up Studies
• Humans
• Hypertension (complications)
• Ischemic Stroke (diagnostic imaging, etiology)
• Male
• Middle Aged
• Neurosurgical Procedures
• Recurrence
• Risk Assessment
• Stroke (diagnostic imaging, etiology, therapy)
• Treatment Outcome