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

Isabel Charlotte Hostettler, Duncan Wilson, Catherine Arnold Fiebelkorn, Diane Aum, Sebastián Francisco Ameriso, Federico Eberbach, Markus Beitzke, Timothy Kleinig, Thanh Phan, Sarah Marchina, Romain Schneckenburger, Maria Carmona-Iragui, Andreas Charidimou, Isabelle Mourand, Sara Parreira, Gareth Ambler, Hans Rolf Jäger, Shaloo Singhal, John Ly, Henry MaEmmanuel Touzé, Ruth Geraldes, Ana Catarina Fonseca, Teresa Melo, Pierre Labauge, Pierre Henry Lefèvre, Anand Viswanathan, Steven Mark Greenberg, Juan Fortea, Marion Apoil, Marion Boulanger, Fausto Viader, Sandeep Kumar, Velandai Srikanth, Ashan Khurram, Franz Fazekas, Veronica Bruno, Gregory Joseph Zipfel, Daniel Refai, Alejandro Rabinstein, Jonathan Graff-Radford, David John Werring

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
JournalJournal of Neurology
DOIs
StateAccepted/In press - 2021

Keywords

  • Cerebral amyloid angiopathy
  • Intracerebral haemorrhage
  • Ischemic stroke
  • Non-traumatic convexity/convexal/cortical subarachnoid haemorrhage
  • Stroke

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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