Mechanistic Evaluation of Diffusion Weighted Hyperintense Lesions After Large Spontaneous Intracerebral Hemorrhage: A Subgroup Analysis of MISTIE III.

Publisher: Humana Press Country of Publication: United States NLM ID: 101156086 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1556-0961 (Electronic) Linking ISSN: 15416933 NLM ISO Abbreviation: Neurocrit Care Subsets: MEDLINE

Original Publication: Totowa, NJ : Humana Press, c2004-

Diffusion Magnetic Resonance Imaging* ; Cerebral Hemorrhage*/diagnostic imaging ; Tissue Plasminogen Activator*/therapeutic use; Humans ; Male ; Female ; Middle Aged ; Aged ; Cerebral Small Vessel Diseases/diagnostic imaging ; Fibrinolytic Agents/therapeutic use ; Brain Ischemia/diagnostic imaging

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.
(© 2023. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.)

Feigin VL, Lawes CM, Bennett DA, Anderson CS. Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol. 2003;2:43–53. (PMID: 10.1016/S1474-4422(03)00266-712849300)
Kidwell CS, Rosand J, Norato G, et al. Ischemic lesions, blood pressure dysregulation, and poor outcomes in intracerebral hemorrhage. Neurology. 2017;88:782–8. (PMID: 10.1212/WNL.0000000000003630281229035344081)
Boulanger M, Schneckenburger R, Join-Lambert C, et al. Diffusion-weighted imaging hyperintensities in subtypes of acute intracerebral hemorrhage. Stroke 2018:Strokeaha118021407.
Murthy SB, Cho SM, Gupta A, et al. A pooled analysis of diffusion-weighted imaging lesions in patients with acute intracerebral hemorrhage. JAMA Neurol 2020.
Menon RS, Burgess RE, Wing JJ, et al. Predictors of highly prevalent brain ischemia in intracerebral hemorrhage. Ann Neurol. 2012;71:199–205. (PMID: 10.1002/ana.22668223679923298034)
Garg RK, Liebling SM, Maas MB, Nemeth AJ, Russell EJ, Naidech AM. Blood pressure reduction, decreased diffusion on MRI, and outcomes after intracerebral hemorrhage. Stroke. 2012;43:67–71. (PMID: 10.1161/STROKEAHA.111.62949321980211)
Prabhakaran S, Gupta R, Ouyang B, et al. Acute brain infarcts after spontaneous intracerebral hemorrhage: a diffusion-weighted imaging study. Stroke. 2010;41:89–94. (PMID: 10.1161/STROKEAHA.109.56625719892994)
Qureshi AI, Palesch YY, Barsan WG, et al. Intensive blood-pressure lowering in patients with acute cerebral hemorrhage. N Engl J Med. 2016;375:1033–43. (PMID: 10.1056/NEJMoa1603460272762345345109)
Hanley DF, Thompson RE, Rosenblum M, et al. Efficacy and safety of minimally invasive surgery with thrombolysis in intracerebral haemorrhage evacuation (MISTIE III): a randomised, controlled, open-label, blinded endpoint phase 3 trial. Lancet. 2019;393:1021–32. (PMID: 10.1016/S0140-6736(19)30195-3307397476894906)
Hemphill JC 3rd, Greenberg SM, Anderson CS, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American heart association/American stroke association. Stroke. 2015;46:2032–60. (PMID: 10.1161/STR.000000000000006926022637)
Morgenstern LB, Hemphill JC 3rd, Anderson C, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2010;41:2108–29. (PMID: 10.1161/STR.0b013e3181ec611b206512764462131)
Kothari RU, Brott T, Broderick JP, et al. The ABCs of measuring intracerebral hemorrhage volumes. Stroke. 1996;27:1304–5. (PMID: 10.1161/01.STR.27.8.13048711791)
Wardlaw JM, Smith EE, Biessels GJ, et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol. 2013;12:822–38. (PMID: 10.1016/S1474-4422(13)70124-8238672003714437)
Tao W, Cheng Y, Guo W, et al. Clinical features and imaging markers of small vessel disease in symptomatic acute subcortical cerebral microinfarcts. BMC Neurol. 2022;22:311. (PMID: 10.1186/s12883-022-02824-w359994949396904)
Fazekas F, Barkhof F, Wahlund LO, et al. CT and MRI rating of white matter lesions. Cerebrovasc Dis. 2002;13(Suppl 2):31–6. (PMID: 10.1159/00004914711901240)
Qureshi AI, Huang W, Lobanova I, et al. Outcomes of intensive systolic blood pressure reduction in patients with intracerebral hemorrhage and excessively high initial systolic blood pressure: post hoc analysis of a randomized clinical trial. JAMA Neurol 2020.
Moullaali TJ, Wang X, Martin RH, et al. Blood pressure control and clinical outcomes in acute intracerebral haemorrhage: a preplanned pooled analysis of individual participant data. Lancet Neurol. 2019;18:857–64. (PMID: 10.1016/S1474-4422(19)30196-631397290)
Gioia LC, Kate M, Choi V, et al. Ischemia in intracerebral hemorrhage is associated with leukoaraiosis and hematoma volume, not blood pressure reduction. Stroke. 2015;46:1541–7. (PMID: 10.1161/STROKEAHA.114.00830425922504)
Nakagawa K, Serrador JM, LaRose SL, Sorond FA. Dynamic cerebral autoregulation after intracerebral hemorrhage: a case-control study. BMC Neurol. 2011;11:108. (PMID: 10.1186/1471-2377-11-108218845743175166)
Kang DW, Han MK, Kim HJ, et al. New ischemic lesions coexisting with acute intracerebral hemorrhage. Neurology. 2012;79:848–55. (PMID: 10.1212/WNL.0b013e3182648a7922843271)
Gregoire SM, Charidimou A, Gadapa N, et al. Acute ischaemic brain lesions in intracerebral haemorrhage: multicentre cross-sectional magnetic resonance imaging study. Brain. 2011;134:2376–86. (PMID: 10.1093/brain/awr17221841203)
Morotti A, Shoamanesh A, Oliveira-Filho J, et al. White matter hyperintensities and blood pressure lowering in acute intracerebral hemorrhage: a secondary analysis of the ATACH-2 trial. Neurocrit Care. 2020;32:180–6. (PMID: 10.1007/s12028-019-00761-031218636)
Sato S, Delcourt C, Heeley E, et al. Significance of Cerebral Small-Vessel Disease in Acute Intracerebral Hemorrhage. Stroke. 2016;47:701–7. (PMID: 10.1161/STROKEAHA.115.01214726846860)

K23NS105948 United States GF NIH HHS; U01-NS080824 United States GF NIH HHS

Keywords: Blood pressure management after intracerebral hemorrhage; Intracerebral hemorrhage; White matter disease

EC 3.4.21.68 (Tissue Plasminogen Activator)
0 (Fibrinolytic Agents)

Date Created: 20231201 Date Completed: 20240603 Latest Revision: 20240822

20240823

10.1007/s12028-023-01890-3

38040993