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Significance of Cerebral Small-Vessel Disease in Acute Intracerebral Hemorrhage.

Abstract：

BACKGROUND AND PURPOSE:The significance of structural changes associated with cerebral small-vessel disease (SVD), including white matter lesions (WML), lacunes, and brain atrophy, to outcome from acute intracerebral hemorrhage is uncertain. We determined associations of computed tomographic radiological manifestations of cerebral SVD and outcomes, and in terms of any differential effect of early intensive blood pressure-lowering treatment, in the large-scale Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2). METHODS:We graded WML (van Swieten scale), the presence of lacunes, and brain atrophy (2 linear measurements and visual rating) for 2069 of 2839 patients with available baseline brain computed tomography (<6 hours of intracerebral hemorrhage onset) by 3 independent neurologists blind to clinical data. RESULTS:WML grade and 2 linear measurements of brain atrophy were associated with death or major disability at 90 days: multivariable-adjusted odds ratios for WML (grade 3 and 4 versus 0), frontal ratio, and third ventricle Sylvian fissure distance (most versus least severe atrophy quartile) were 1.42 (95% confidence interval, 1.02-1.98), 1.47 (1.08-1.99), and 1.64 (1.21-2.22), respectively (all P for trend <0.05). There was no association between lacunes and outcomes. There were no significant differences in the effects of intensive blood pressure-lowering across subgroups of cerebral SVD. CONCLUSIONS:Preexisting cerebral SVD manifestations of WML and brain atrophy predict poor outcome in acute intracerebral hemorrhage. There is no apparent hazard of early intensive lowering of blood pressure according to the INTERACT2 protocol, in patients with underlying cerebral SVD. CLINICAL TRIAL REGISTRATION:URL: http://www.clinicaltrials.gov. Unique identifier: NCT00716079.

journal_name

Stroke

journal_title

Stroke

authors

Sato S,Delcourt C,Heeley E,Arima H,Zhang S,Al-Shahi Salman R,Stapf C,Woo D,Flaherty ML,Vagal A,Levi C,Davies L,Wang J,Robinson T,Lavados PM,Lindley RI,Chalmers J,Anderson CS,INTERACT2 Investigators.

doi

10.1161/STROKEAHA.115.012147

subject

Has Abstract

pub_date

2016-03-01 00:00:00

pages

701-7

issue

eissn

0039-2499

issn

1524-4628

pii

STROKEAHA.115.012147

journal_volume

pub_type

杂志文章,多中心研究,随机对照试验

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Significance of Cerebral Small-Vessel Disease in Acute Intracerebral Hemorrhage.