Welcome to the WSC 2022 Interactive Program

Background and Aims

Moderate blood pressurereduction reduces haematoma expansion but is not clearly translated into functional recovery in intracerebral haemorrhage. This study aims to explore patient profiles and the treatment effect of different intensities of BP-lowering treatment by haematoma expansion trajectories.

Methods

Post-hoc analysis of the Blood pressure in Acute Stroke Collaboration (BASC) dataset. Latent class analysis was used to identify trajectories of haematoma volume obtained at baseline and 24 hours. Generalised linear mixed models were used with adjustment of confounders and source trial as a random effect for clustering.

Results

2450 patients (mean age 64.1+13.1 years, female 36.7%) were included, with four patterns of haematoma trajectory identified: stable expansion with favourable outcome (52.1%, median expansion 0.2 [IQR -0.4-1.1] ml, median mRS 2 [IQR 1-2]), mild expansion with disability (32.6%, 0.8 [-0.8-4.6] ml, mRS 4[4-5]), moderate expansion with disability (13.2%, 11.2 [4.9-27.0] ml, mRS 4[3-6]) and large expansion with unfavourable outcome (2.1%, 35.2 [12.8-81.2] ml, mRS 6[6-6]). The baseline haematoma (ml) was 6.8, 13.2, 27.1 and 59.2 for each group, respectively. Patients with large growth were younger and more likely to receive neurosurgery than the mild group. BP-lowering treatment effect on functional outcomes was similar across the four groups (p for heterogeneity=0.23). However, intensive BP-lowering treatment increased the risk of any SAEs in patients with stable expansion (adjusted odds ratio 1.62 [1.08-2.43], p for heterogeneity<0.001).

Conclusions

Intensive BP-lowering treatment did not improve functional recovery across different haematoma expansion trajectories but increased the risk of any SAEs in patients with stable haematoma growth.

Background and Aims

Haematoma expansion (HE) was defined as an increase of haematoma volume of >6 mL or >33% from baseline in the Tranexamic acid for IntraCerebral Haemorrhage-2 (TICH-2) trial. However, different magnitudes of HE may affect prognosis based on baseline haematoma volume. We tested this hypothesis using data from TICH-2.

Methods

2273 TICH-2 patients with baseline and 24-hour follow-up CT scans were included. HE was defined as a volume increase of >2, 4, 6, 8 and 10 mL on follow-up CT. Multivariable logistic regression with adjustment of key prognostic factors was performed to determine the effect of haematoma expansion on death and dependency (modified Rankin Scale of 4 to 6) according to each category of baseline haematoma volume (<15mL, 15-30mL, 30-60mL and >60mL).

Results

The baseline haematoma volume was <15mL in 1226(52.7%), 15-30mL in 425(18.3%), 30-60mL in 365(15.7%) and >60mL in 257 (11.1%). 745(35.9%) participants had HE of >2 mL, 525(22.6%) >4mL, 422(18.2%) >6mL, 360(15.5%) >8mL, 321(13.8%) >10mL and 570(24.5%) >6mL/>33%. All categories of HE did not increase the risk of death and dependency further in patients with baseline haematoma volume of >60 mL. Conversely all categories of HE increased death and dependency in baseline volume <60 mL. AUROC were similar for all HE cut-offs (0.85) but was lower when >6 mL or >33% was used (0.81).

Conclusions

Haematoma expansion, regardless of magnitude, did not have additional prognostic significance in patients with baseline haematoma volume >60mL but any extent of haematoma expansion predicted worse outcome in those <60mL.

Background and Aims

We assessed the effect of early perihaematomal oedema (PHO) and expansion on outcomes using pooled data from control arm of Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial-2 and Tranexamic acid for intracerebral haemorrhage-2 trial.

Methods

1233 ICH participants recruited within 6 hours of ictus with baseline and follow-up 24-hour computed tomography (CT) scans were included. ICH volume (ICHV) and PHO volume (PHOV) were measured using semi-automated segmentation. The oedema extension distance (OED) was computed. Absolute oedema expansion was the difference in PHOV between baseline and 24-hour CT and relative expansion was expressed as a % of PHO expansion to baseline PHO. Multivariable logistic regression was used to assess the effects on early death, acute neurological deterioration and day 90 modified Rankin Scale (mRS) >3.

Results

The mean age was 68.9(14.0) years and the mean time from ictus-to-baseline-CT was 2.2(1.2) hours. At baseline: ICHV was 24.0(27.5) mL, PHOV was 12.8(15.5) mL and OED 0.27(0.20) cm. The absolute oedema expansion was 6.5(12.7) mL and the relative oedema expansion was 102(279) %. In adjusted analysis, baseline PHO and OED were not associated with clinical outcomes. Absolute oedema expansion significantly increased the risk of early death (aOR 1.04, 1.02-1.05), acute neurological deterioration (aOR 1.04, 1.02-1.05) and day 90 mRS>3 (aOR 1.03, 1.01-1.05). Relative oedema expansion increased the risk of early death and acute neurological deterioration (aOR per 10% increase 1.01, 1.01-1.02 for both).

Conclusions

Increase in PHO over 24 hours predicts poor functional outcome and could be a potential therapeutic target in future clinical trials.

Background and Aims

Although a rare event, spontaneous intracerebral hemorrhage during pregnancy and postpartum period (pICH) is one of the leading causes of maternal deaths worldwide. Our objective was to study the etiology, risk factors and outcomes of pICH according to the SMASH-U etiological classification system.

Methods

We performed a retrospective population-based cohort study and a nested case-control study in Finland 1987-2016 (SIPP-FIN). Women with incident stroke during pregnancy and puerperium were identified by linking the Medical Birth Register and the Hospital Discharge Register. A subcohort of women with ICH was included in this analysis. Clinical details were collected from patient records. Each woman with ICH had three matched controls.

Results

Altogether, 48 pICH cases were identified. Of these, 24 (50%) cases occurred during pregnancy and 24 (50%) during peripartum and puerperium. Of 48 pICH patients, 17 (35.4%) had a systemic disease, either preeclampsia, eclampsia or HELLP-syndrome as etiology; 15 (31.3%) patients had a structural vascular lesion, 15 (31.3%) patients had an undetermined etiology, and lastly, 1 (2.1%) patient had chronic hypertension. The most important risk factors for ICH when comparing ICH-cases with controls were hypertensive disorders of pregnancy (OR 3.8, 95% CI 1.6-9.2) and foremost preeclampsia or eclampsia (OR 8.1, 95% CI 2.4-27.6). Maternal mortality was 12.5%, whilst 79.2% of patients had a good recovery (mRS 0-2).

Conclusions

The maternal mortality rate for pregnancy-related ICH is high, and the sequelae are severe. Early recognition and treatment of the key risk factor, hypertensive disorders of pregnancy, is crucial for the prevention of this serious pregnancy complication.

Background and Aims

Background: Spontaneous intracerebral haemorrhage (sICH) is associated with a high case fatality rate in resource-limited settings. The independent predictors of poor outcome after ICH in sub -Saharan Africa remains to be characterized in large epidemiological studies.

Aims: To determine factors associated with 30-day fatality among West African patients with sICH

Methods

A multicentre study of consecutive patients with spontaneous ICH confirmed with computerized tomography or magnetic resonance imaging scans encountered at 15hospitals in Ghana and Nigeria between 2015 and 2018. Data on demographic, cardiovascular risk factors, clinical features, and neuroimaging markers of severity such as haematoma volume and presence of intraventricular extension were assessed. The Independent risk factors for 30-day mortality were determined using a multivariate logistic regression analysis with an adjusted odds ratio(OR) and 95% confidence interval(CI).

Results

Among 964 patients with sICH, 590 (61.2%) were males with a mean age of 54.3 (SD 13.6) years and a case fatality of 34.3%. Factors associated with 30-day mortality were: National Institutes of Health Stroke Scale (NIHSS) score >15: (OR 3.11; 95% CI1.17-8.24), Glasgow coma scale (GCS) score of 3-4;(OR 7.18; 95% CI1.97-26.22), systolic blood pressure;(OR 1.02; 95% CI0.99-1.04), presence of aspiration pneumonitis;(OR 10.47; 95% CI(4.11- 26.67) and regular(>once per week) consumption of leafy vegetables(OR 0.38; 95% CI 0.15-0.96) which was protective against fatality.

Conclusions

Peculiar adverse and protective factors are associated with 30-day mortality among West Africans with spontaneous ICH. These factors should be further investigated in other populations in Africa to enable the development of ICH mortality predictions models among indigenous Africans.