Mechanistic Evaluation of Diffusion Weighted Hyperintense Lesions After Large Spontaneous Intracerebral Hemorrhage : A Subgroup Analysis of MISTIE III
© 2023. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society..
BACKGROUND: Ischemic lesions on diffusion weighted imaging (DWI) are common after acute spontaneous intracerebral hemorrhage (ICH) but are poorly understood for large ICH volumes (> 30 mL). We hypothesized that large blood pressure drops and effect modification by cerebral small vessel disease markers on magnetic resonance imaging (MRI) are associated with DWI lesions.
METHODS: This was an exploratory analysis of participants in the Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation phase 3 trial with protocolized brain MRI scans within 7 days from ICH. Multivariable logistic regression analysis was performed to assess biologically relevant factors associated with DWI lesions, and relationships between DWI lesions and favorable ICH outcomes (modified Rankin Scale 0-3).
RESULTS: Of 499 enrolled patients, 300 had MRI at median 7.5 days (interquartile range 7-8), and 178 (59%) had DWI lesions. The incidence of DWI lesions was higher in patients with systolic blood pressure (SBP) reduction ≥ 80 mm Hg in first 24 h (76%). In adjusted models, factors associated with DWI lesions were as follows: admission intraventricular hematoma volume (p = 0.03), decrease in SBP ≥ 80 mm Hg from admission to day 1 (p = 0.03), and moderate-to-severe white matter disease (p = 0.01). Patients with DWI lesions had higher odds of severe disability at 1 month (p = 0.04), 6 months (p = 0.036), and 12 months (p < 0.01). No evidence of effect modification by cerebral small vessel disease on blood pressure was found.
CONCLUSIONS: In patients with large hypertensive ICH, white matter disease, intraventricular hemorrhage volume, and large reductions in SBP over the first 24 h were independently associated with DWI lesions. Further investigation of potential hemodynamic mechanisms of ischemic injury after large ICH is warranted.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2023 |
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| Enthalten in: |
Neurocritical care - (2023) vom: 01. Dez. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Rivera-Lara, Lucia [VerfasserIn] |
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| Links: |
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| Themen: |
Blood pressure management after intracerebral hemorrhage |
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| Anmerkungen: |
Date Revised 01.12.2023 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1007/s12028-023-01890-3 |
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| Förderinstitution / Projekttitel: |
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NLM365319813 |
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| 100 | 1 | |a Rivera-Lara, Lucia |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Mechanistic Evaluation of Diffusion Weighted Hyperintense Lesions After Large Spontaneous Intracerebral Hemorrhage |b A Subgroup Analysis of MISTIE III |
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| 520 | |a © 2023. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society. | ||
| 520 | |a BACKGROUND: Ischemic lesions on diffusion weighted imaging (DWI) are common after acute spontaneous intracerebral hemorrhage (ICH) but are poorly understood for large ICH volumes (> 30 mL). We hypothesized that large blood pressure drops and effect modification by cerebral small vessel disease markers on magnetic resonance imaging (MRI) are associated with DWI lesions | ||
| 520 | |a METHODS: This was an exploratory analysis of participants in the Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation phase 3 trial with protocolized brain MRI scans within 7 days from ICH. Multivariable logistic regression analysis was performed to assess biologically relevant factors associated with DWI lesions, and relationships between DWI lesions and favorable ICH outcomes (modified Rankin Scale 0-3) | ||
| 520 | |a RESULTS: Of 499 enrolled patients, 300 had MRI at median 7.5 days (interquartile range 7-8), and 178 (59%) had DWI lesions. The incidence of DWI lesions was higher in patients with systolic blood pressure (SBP) reduction ≥ 80 mm Hg in first 24 h (76%). In adjusted models, factors associated with DWI lesions were as follows: admission intraventricular hematoma volume (p = 0.03), decrease in SBP ≥ 80 mm Hg from admission to day 1 (p = 0.03), and moderate-to-severe white matter disease (p = 0.01). Patients with DWI lesions had higher odds of severe disability at 1 month (p = 0.04), 6 months (p = 0.036), and 12 months (p < 0.01). No evidence of effect modification by cerebral small vessel disease on blood pressure was found | ||
| 520 | |a CONCLUSIONS: In patients with large hypertensive ICH, white matter disease, intraventricular hemorrhage volume, and large reductions in SBP over the first 24 h were independently associated with DWI lesions. Further investigation of potential hemodynamic mechanisms of ischemic injury after large ICH is warranted | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Blood pressure management after intracerebral hemorrhage | |
| 650 | 4 | |a Intracerebral hemorrhage | |
| 650 | 4 | |a White matter disease | |
| 700 | 1 | |a Cho, Sung-Min |e verfasserin |4 aut | |
| 700 | 1 | |a Li, Yunke |e verfasserin |4 aut | |
| 700 | 1 | |a Ali, Hasan |e verfasserin |4 aut | |
| 700 | 1 | |a McBee, Nichol |e verfasserin |4 aut | |
| 700 | 1 | |a Awad, Issam A |e verfasserin |4 aut | |
| 700 | 1 | |a Avadhani, Radhika |e verfasserin |4 aut | |
| 700 | 1 | |a Hanley, Daniel F |e verfasserin |4 aut | |
| 700 | 1 | |a Gandhi, Dheeraj |e verfasserin |4 aut | |
| 700 | 1 | |a Walborn, Nathan |e verfasserin |4 aut | |
| 700 | 1 | |a Murthy, Santosh B |e verfasserin |4 aut | |
| 700 | 1 | |a Ziai, Wendy C |e verfasserin |4 aut | |
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