Small Vessel Disease Burden In Survivors Of Intracerebral Hemorrhage And Its Relationship With Hematoma Expansion

Objective:Hypertensive intracerebral hemorrhage and cerebral amyloid angiopathy are the main types of intracerebral hemorrhage(ICH).Epidemiological studies have found that ICH and cerebral small vessel disease(CSVD)share many risk factors.Clinical cohort studies have found that patients with cerebral hemorrhage can be combined with new subcortical lacunar infarction before and after cerebral hemorrhage.This study aims to evaluate the detection rate and risk factors of CSVD burden in patients with ICH,and to explore its relationship with hematoma expansion(HE).Methods:Patients with intracerebral hemorrhage between January 1,2020 and December 31,2022 were continuously enrolled in a single center.Patients with baseline computed tomography(CT)< 6 hours and follow-up CT < 24 hours were enrolled.Patients with secondary intracerebral hemorrhage,no Magnetic Resonance Imaging(MRI),and surgery or death within 24 hours were excluded.MRI was used to evaluate the changes of CSVD imaging marker burden in ICH patients,and the patients were grouped according to the presence of lacunae,white matter hyperintensities(WMH)and the severity of microbleeds(CMBs).SPSS 27.0 software was used for statistical analysis.Multivariate logistic analysis was used to evaluate the risk factors for the presence of lacunes,severe white matter hyperintensities(Fazekas score of DWMH 2-3 or PVH 3)and multiple severe microbleeds(CMBs >4).Patients were grouped according to the presence or absence of HE.Univariate analysis was used to evaluate the relationship between hematoma expansion and total burden.HE was defined as new intraventricular hemorrhage(IVH)relative to baseline hematoma or >6mL if baseline ICH volume was <20mL;HE was defined as ≥ 33% if the baseline volume was >20mL.Results:1.A total of 98 patients with intracerebral hemorrhage were enrolled in this study,with an average age of 61.56(± 10.86)years.There were 62males(63.3%).The prevalence of lacunar cavity was 73.5%,the prevalence of DWMH grade 2-3 or PVH grade 3 was 50%,the prevalence of CMBs was73.5%,and the prevalence of CMBs > 4 was 33.7%.2.Univariate logistic regression analysis showed that the presence of lacunae was associated with hypertension(OR=6.200;95%CI 2.239-17.166;P<0.001)and history of cerebral infarction(OR=4.078;95%CI 1.114-14.923;P=0.034).After adjusting for age and gender,only hypertension(OR=9.748;95%CI 2.993-31.746;P<0.001)were associated with the presence of lacunes,and the presence of lacunes increased with the increase of hypertension in ICH patients.3.Univariate logistic regression analysis of severe WMH and age(OR=1.076;95%CI 1.03-1.124;P<0.001),hypertension(OR=3.807;95%CI=1.35-10.741;P=0.012),history of cerebral infarction(OR=3.534;95%CI 1.37-9.119;P=0.009)and total cholesterol(OR=0.561;95%CI0.339-0.927;P=0.024).After adjusting for age and gender,only age(OR=1.078;95%CI 1.027-1.131;P=0.02)and hypertension(OR=7.829;95%CI 2.600-23.579;P<0.01)were associated with severe WMH,and the occurrence of DWMH grade 2-3 or PVH grade 3 in ICH patients increased with age and hypertension.4.Univariate logistic regression analysis of severe CMBs and hypertension(OR=16.372;95%CI 2.096-127.89;P=0.008)and history of cerebral infarction(OR=5.216;95%CI 2.034-13.373;P<0.001).After adjusting for age and gender,multivariate logistic regression analysis showed that hypertension(OR=17.687;95%CI 1.901-164.604;P=0.012)and history of cerebral infarction(OR=6.700;95%CI 2.007-22.367;P=0.002)were still associated with CMBs>4,and the presence of CMBs>4 increased with the history of hypertension and cerebral infarction in ICH patients.5.Hematoma expansion occurred in 8 of 98 enrolled patients(8%)with intracerebral hemorrhage.There was no significant difference between HE and lacunar presence(P=0.412),severe microbleeds(P=0.684),and severe white matter hyperintensities(P=1).There was no significant difference between the total burden of imaging changes and CSVD(P=0.445).Conclusions:1.Lacunar lesions,severe white matter hyperintensities and severe microbleeds are detected more frequently in surviving ICH patients,suggesting that ICH patients often have a severe ischemic burden.2.Hypertension is a common independent risk factor for the presence of lacunae,severe white matter hyperintensities,and severe microbleeds in ICH patients.Age is an independent risk factor for severe white matter hyperintensities in ICH patients.History of cerebral infarction is an independent risk factor for severe microbleeds in patients with ICH.3.There was no direct correlation between HE and total CSVD burden in ICH patients.