Combined effect of cortical superficial siderosis and cerebral microbleed on short-term and long-term outcomes after intracerebral haemorrhage

• Published in: Stroke and vascular neurology 2024-08, Vol.9 (4), p.429-438
• Main Authors: Jin, Yujia, Huang, Yu-hui, Chen, Yu-ping, Zhang, Yao-dan, Li, Jiawen, Yang, Kai-cheng, Ye, Xianghua, Jin, Lu-hang, Wu, Jian, Yuan, Chang-zheng, Gao, Feng, Tong, Lu-sha
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Cardiac arrhythmia; Cardiovascular disease; Cerebral Hemorrhage - diagnostic imaging; Cerebral Hemorrhage - mortality; Cerebral Hemorrhage - therapy; Cerebrovascular Disorders; Databases, Factual; Disability Evaluation; Female; Functional Status; Hemorrhage; Humans; Ischemia; Magnetic Resonance Imaging; Male; Middle Aged; Mortality; Original Research; Prognosis; Recovery of Function; Recurrence; Registries; Retrospective Studies; Risk Assessment; Risk Factors; Siderosis - diagnostic imaging; Siderosis - mortality; Siderosis - therapy; Stroke; Time Factors; Transient ischemic attack
• ISSN: 2059-8688; 2059-8696; 2059-8696
• DOI: 10.1136/svn-2023-002439

Background and purposeCortical 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.MethodsBased 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).ResultsA 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+.ConclusionsPatients 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.Trial registration numberNCT04803292.