Influence of Intracerebral Haemorrhage Location on Stroke Outcomes

Sarfaroj Khan 

July 09, 2020

Takeaway

  • In intracerebral haemorrhage (ICH) survivors, lobar ICH location was associated with an increased risk of recurrent ICH events than non-lobar ICH.

  • However, the risk of subsequent cerebral ischaemic events was not influenced by the ICH location.

Why this matters

  • Findings suggest that factors beyond ICH location are crucial for identifying those at highest risk of subsequent stroke events and that severe small vessel disease, regardless of subtype, is important.

Study design

  • 1094 patients with imaging confirmed spontaneous ICH recruited to the CROMIS-2 ICH study were included (mean age, 73.3 years; 57.4% male).

  • Main outcome: occurrence of a cerebral ischaemic event (either stroke or transient ischaemic attack) or a further ICH following study entry.

  • Funding: CROMIS-2 study is funded by the Stroke Association and British Heart Foundation.

Key results

  • At 3-year follow-up, 45 recurrent ICH events were reported (absolute event rate [AER], 1.88 per 100 patient-years), of which, 35 were in patients presenting with lobar ICH (AER, 3.77 per 100 patient-years) and 9 in those with non-lobar ICH (AER, 0.69 per 100 patient-years).

  • Multivariable Cox regression found that lobar ICH location at presentation remained associated with subsequent ICH occurrence (HR, 8.96; 95% CI, 3.36-23.87; P<.0001); similar results were seen in multivariable completing risk analyses.

  • Overall, 70 cerebral ischaemic events were reported (AER, 2.93 per 100 patient-years), of which, 29 were in patients with lobar ICH (AER, 3.12 per 100 patient-years) and 39 in those with non-lobar ICH (AER, 2.97 per 100 patient-years).

  • Multivariable Cox regression found no significant association between ICH location and cerebral ischaemic events (HR, 1.13; 95% CI, 0.66-1.92; P=.659) with similar results seen in completing risk analyses.

Limitations

  • Selection bias.

Banerjee G, Wilson D, Ambler G, Hostettler IC, Shakeshaft C, Cohen H, Yousry T, Al-Shahi Salman R, Lip GYH, Houlden H, Muir KW, Brown MM, Jäger HR, Werring DJ. Longer term stroke risk in intracerebral haemorrhage survivors. J. Neurol. Neurosurg. Psychiatry. 2020 Jun 17 [Epub ahead of print]. doi: 10.1136/jnnp-2020-323079. PMID: 32554800 Abstract.

This clinical summary first appeared on Univadis, part of the Medscape Professional Network.

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