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Abstract
Background and Objectives To study the relationship between the presence of cerebral microbleeds (CMBs) and acute hematoma characteristics among patients with primary intracerebral hemorrhage (ICH).
Methods We pooled individual patient data from the Antihypertensive Treatment of Acute Cerebral Hemorrhage 2 (ATACH-2) trial and the Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation phase 3 (MISTIE III) trial. We included individuals with a brain MRI scan. Exposure was the presence of a CMB. The coprimary outcomes were admission ICH volume and hematoma expansion. Mixed-effects linear and logistic regression models were used, with demographics and comorbid conditions considered fixed effects and the study cohort treated as a random effect. Additional analyses assessed the relationship between CMB topography and number and hematoma characteristics.
Results Of the 1,499 patients with ICH enrolled in the parent trials, 466 (31.1%) were included in this analysis, and 231 (49.6%) patients had CMBs. In adjusted models, presence of CMBs was associated with smaller ICH volume (β = −0.26, 95% confidence interval [CI] −0.44 to −0.08) and lower odds of hematoma expansion (odds ratio 0.65, 95% CI 0.40–0.95; p = 0.04). The strength of association between CMBs and hematoma characteristics increased with increasing number of CMBs. The location of the CMBs and the severity of leukoaraiosis did not modify these results.
Discussion In a pooled cohort of patients with ICH, our results are consistent with the hypothesis that more severe underlying small vessel disease, as represented by CMBs, leads to smaller baseline hematoma volumes and reduced hematoma expansion. Underlying cerebral small vessel disease may be of prognostic significance after ICH.
Trial Registration Information ClinicalTrials.gov Identifier: NCT01176565 and NCT01827046.
Classification of Evidence This study provides Class II evidence that the presence of microbleeds on MRI is associated with a smaller ICH volume at presentation and a lower rate of hematoma expansion on follow-up imaging.
Glossary
- ATACH-2=
- Antihypertensive Treatment of Acute Cerebral Hemorrhage 2;
- CI=
- confidence interval;
- CMB=
- cerebral microbleed;
- CSVD=
- cerebral small vessel disease;
- ICH=
- intracerebral hemorrhage;
- MISTIE III=
- Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation phase 3;
- OR=
- odds ratio;
- WMH=
- white matter hyperintensities
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
↵* These authors contributed equally to this work.
Class of Evidence: NPub.org/coe
- Received May 10, 2021.
- Accepted in final form December 13, 2021.
- © 2021 American Academy of Neurology
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