Cerebral small vessel disease and prognosis in intracerebral haemorrhage: A systematic review and meta‐analysis of cohort studies

Abstract

Background and purpose The aim was to investigate whether cerebral small vessel disease (CSVD) markers and the total CSVD burden are associated with functional outcome, mortality, stroke recurrence and haematoma expansion in patients with spontaneous intracerebral haemorrhage (ICH). Methods Following a previously registered protocol (PROSPERO protocol: CRD42021287743), PubMed, Web of Science and Embase were systematically searched to identify relevant literature up to November 2021. Cohort studies that examined the association between CSVD markers (white matter hyperintensity [WMH], lacune, enlarged perivascular space [EPVS], cerebral microbleed [CMB] and brain atrophy) or CSVD burden and prognosis in patients with ICH were included. The pooled estimates were calculated using random effects models. Results Forty‐one studies with 19,752 ICH patients were pooled in the meta‐analysis. WMH (odds ratio [OR] 1.50, 95% confidence interval [CI] 1.32–1.70), lacune (OR = 1.32, 95% CI 1.18–1.49), CMB (OR = 2.60, 95% CI 1.13–5.97) and brain atrophy (OR = 2.22, 95% CI 1.48–3.31) were associated with worse functional outcome. CSVD markers concerning increased risk of mortality were WMH (OR = 1.57, 95% CI 1.38–1.79) and brain atrophy (OR = 1.84, 95% CI 1.11–3.04), and markers concerning increased risk of stroke recurrence were WMH (OR = 1.62, 95% CI 1.28–2.04) and lacune (OR = 3.00, 95% CI 1.68–5.37). Enlarged perivascular space was not related to prognosis. There was a lack of association between CSVD markers and haematoma expansion. CSVD burden increased the risk of worse functional outcome, mortality and stroke recurrence by 57%, 150% and 44%, respectively. Conclusions In patients with spontaneous ICH, WMH, lacune, CMB, brain atrophy and the total CSVD burden are associated with substantially increased risk of worse functional outcome, mortality or stroke recurrence.

Associations between computed tomography markers of cerebral small vessel disease and hemorrhagic transformation after intravenous thrombolysis in acute ischemic stroke patients

“…Computed tomography can assess several CSVD markers, including leukoaraiosis, lacune and brain atrophy ( 17 ). These markers may be useful for identifying patients at higher risk of intracerebral hemorrhage ( 18 ). Although magnetic resonance imaging is typically used to evaluate CSVD markers, CT offers faster assessment, which can be critical in time-sensitive situations such as IVT for AIS ( 19 ).…”

Cerebral small vessel disease: a bibliometric analysis

“…They are usually symmetrically distributed in the white matter including the pons and brain stem on imaging, and also in the deep gray matter(Wu et al, 2022;Hu et al, 2022). White matter hyperintensities (WMH) are the most important predictors of gait dysfunction, and more severe WMH-related defects are located in the internal capsule, Centrum semiovale), periventricular frontal lobe, etc(Rudilosso et al, 2022;Cheng et al, 2022). The number of lacunar infarcts is a predictor of executive dysfunction, presumably due to damage to the frontal-subcortical circuit, decreased connectivity and metabolism within the prefrontal cortex, and ultimately executive dysfunction(Huang et al, 2022;Tian et al, 2022).…”

Peak width of skeletonized mean diffusivity (PSMD) as neuroimaging biomarker for vascular cognitive impairment in the context of cerebral amyloid angiopathy

“…31 However, other than its potential diagnostic utility, evidence on PVS's prognostic value is still scarce, especially in CAA, and its clinical value remains undefined. A recent meta-analysis found that PVS were not associated with post-ICH prognosis, 96 but previous studies indicate an association between high burden of CSO-PVS and risk of recurrent ICH. 103,104 Recent investigations in CAA do not report a significant association between PVS and cognitive performance, 53,105 but in population-based studies, higher burden of PVS has been associated with worse cognition and increased risk of dementia.…”

“…95 In patients with ICH, lacunes were associated with worse functional outcomes and increased recurrence. 96 Specific prognostic data on CAA patients is scarce.…”

“…In patients with ICH, brain atrophy 36 has been associated with worse functional outcomes and mortality. 96 In cSVD patients, atrophy correlates with cognitive performance, 108,109 and often outperforms other neuroimaging markers. 109 However, disentangling which component of the atrophy is attributed to neurodegenerative or vascular pathologies remains challenging.…”