Diffusion-Weighted Imaging Lesions After Intracerebral Hemorrhage and Risk of Stroke
- 20 January 2021
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Stroke
- Vol. 52 (2), 595-602
- https://doi.org/10.1161/strokeaha.120.031628
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.This publication has 28 references indexed in Scilit:
- High Prevalence of Cerebral Microbleeds in Inner City Young Stroke PatientsJournal of Stroke and Cerebrovascular Diseases, 2016
- Predictors of 30-Day Readmission After Intracerebral HemorrhageCritical Care Medicine, 2013
- New ischemic lesions coexisting with acute intracerebral hemorrhageNeurology, 2012
- Ischemic Brain Injury After Intracerebral HemorrhageStroke, 2012
- Blood Pressure Reduction, Decreased Diffusion on MRI, and Outcomes After Intracerebral HemorrhageStroke, 2012
- Predictors of highly prevalent brain ischemia in intracerebral hemorrhageAnnals of Neurology, 2011
- Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH) II: Design, Methods, and RationaleNeurocritical Care, 2011
- Silent ischemic infarcts are associated with hemorrhage burden in cerebral amyloid angiopathyNeurology, 2009
- The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational StudiesAnnals of Internal Medicine, 2007
- MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal agingAmerican Journal of Roentgenology, 1987