Neurology Department, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
School of Public Health, Zhejiang University, Hangzhou, China.
Stroke Vasc Neurol. 2024 Aug 27;9(4):429-438. doi: 10.1136/svn-2023-002439.
Cortical superficial siderosis (cSS) and cerebral microbleed (CMB) have distinct effects on intracerebral haemorrhage (ICH). We aim to investigate the combined effect of cSS and CMB on outcomes after ICH.
Based on a single-centre stroke registry database, patients with spontaneous ICH who had CT scan within 48 hours after ictus and MRI subsequently were identified. Eligible patients were divided into four groups (cSS-CMB-, cSS-CMB+, cSS+CMB-, cSS+CMB+) according to cSS and CMB on susceptibility-weighted image of MRI. Primary outcomes were haematoma volume on admission and unfavourable outcome defined as modified Rankin Scale scores ≥3 at 3 months. Secondary outcomes were all-cause death, recurrence of stroke and ICH during follow-up (median follow-up 2.0 years, IQR 1.0-3.0 years).
A total of 673 patients were identified from 1044 patients with spontaneous ICH. 131 (19.5%) had cSS and 468 (69.5%) had CMB. Patients with cSS+CMB+ had the highest rate of poor outcome at 3 months, as well as all-cause death, recurrent stroke and ICH during follow-up. In cSS- patients, CMB was associated with smaller haematoma (β -0.13; 95% CI -0.22 to -0.03; p=0.009), but it still increased risks of recurrent ICH (OR 4.6; 95% CI 1.3 to 15.6; p=0.015) and stroke (OR 2.0; 95% CI 1.0 to 4.0; p=0.049). These effects of CMB became unremarkable in the context of cSS+.
Patients with different combinations of cSS and CMB have distinct patterns of short-term and long-term outcomes. Although CMB is related to restrained haematoma, it does not improve long-term outcomes.
NCT04803292.
皮质浅表铁沉积（cSS）和脑微出血（CMB）对脑出血（ICH）有不同的影响。我们旨在研究 cSS 和 CMB 对 ICH 后结局的联合影响。
基于单中心卒中登记数据库，确定了发病后 48 小时内行 CT 扫描且随后行 MRI 的自发性 ICH 患者。根据 MRI 磁敏感加权成像上的 cSS 和 CMB，将符合条件的患者分为四组（cSS-CMB-、cSS-CMB+、cSS+CMB-、cSS+CMB+）。主要结局为入院时血肿体积和 3 个月时改良 Rankin 量表评分≥3 的不良结局。次要结局为随访期间的全因死亡、卒中复发和 ICH（中位随访 2.0 年，IQR 1.0-3.0 年）。
从 1044 例自发性 ICH 患者中确定了 673 例患者。131 例（19.5%）有 cSS，468 例（69.5%）有 CMB。cSS+CMB+患者 3 个月时不良结局发生率最高，且随访期间全因死亡、卒中复发和 ICH 发生率最高。在 cSS-患者中，CMB 与血肿较小相关（β -0.13；95%CI -0.22 至 -0.03；p=0.009），但仍增加了复发性 ICH 的风险（OR 4.6；95%CI 1.3 至 15.6；p=0.015）和卒中的风险（OR 2.0；95%CI 1.0 至 4.0；p=0.049）。在 cSS+的情况下，CMB 的这些影响变得不明显。
不同 cSS 和 CMB 组合的患者具有不同的短期和长期结局模式。尽管 CMB 与血肿受限有关，但它并不能改善长期结局。
NCT04803292。
