Perihematomal Edema and Clinical Outcome After Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis

Marchina, Sarah; Trevino-Calderon, Jorge A; Hassani, Sara; Massaro, Joseph M.; Lioutas, Vasileios‐Arsenios; Carvalho, Filipa; Selim, Magdy

doi:10.1007/s12028-022-01512-4

Cited by 12 publications

(8 citation statements)

References 58 publications

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“…However, our study's scope is somewhat constrained by the absence of 72-h follow-up data, which would have provided a broader temporal context for comparison with prior studies. 3,27,28 Furthermore, the predominance of Asian participants, exceeding 50%, may potentially introduce an underrepresentation bias in our analyses. Our study is influenced by the ATACH-2 inclusion criteria, with sample bias limited to supratentorial ICH, presented with elevated admission systolic blood pressure exceeding 180 mmHg and a baseline hematoma volume under 60 mL.…”

Section: Discussionmentioning

confidence: 99%

Peri-hematomal edema shape features related to 3-month outcome in acute supratentorial intracerebral hemorrhage

Dierksen,

Tran,

Zeevi

et al. 2024

European Stroke Journal

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Introduction: Perihematomal edema (PHE) represents secondary brain injury and a potential treatment target in intracerebral hemorrhage (ICH). However, studies differ on optimal PHE volume metrics as prognostic factor(s) after spontaneous, non-traumatic ICH. This study examines associations of baseline and 24-h PHE shape features with 3-month outcomes. Patients and methods: We included 796 patients from a multicentric trial dataset and manually segmented ICH and PHE on baseline and follow-up CTs, extracting 14 shape features. We explored the association of baseline, follow-up, difference (baseline/follow-up) and temporal rate (difference/time gap) of PHE shape changes with 3-month modified Rankin Score (mRS) – using Spearman correlation. Then, using multivariable analysis, we determined if PHE shape features independently predict outcome adjusting for patients’ age, sex, NIH stroke scale (NIHSS), Glasgow Coma Scale (GCS), and hematoma volume. Results: Baseline PHE maximum diameters across various planes, main axes, volume, surface, and sphericity correlated with 3-month mRS adjusting for multiple comparisons. The 24-h difference and temporal change rates of these features had significant association with outcome – but not the 24-h absolute values. In multivariable regression, baseline PHE shape sphericity (OR = 2.04, CI = 1.71–2.43) and volume (OR = 0.99, CI = 0. 98–1.0), alongside admission NIHSS (OR = 0.86, CI = 0.83–0.88), hematoma volume (OR = 0.99, CI = 0. 99–1.0), and age (OR = 0.96, CI = 0.95–0.97) were independent predictors of favorable outcomes. Conclusion: In acute ICH patients, PHE shape sphericity at baseline emerged as an independent prognostic factor, with a less spherical (more irregular) shape associated with worse outcome. The PHE shape features absolute values over the first 24 h provide no added prognostic value to baseline metrics.

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Section: Discussionmentioning

confidence: 99%

Peri-hematomal edema shape features related to 3-month outcome in acute supratentorial intracerebral hemorrhage

Dierksen,

Tran,

Zeevi

et al. 2024

European Stroke Journal

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“…Hematoma volume is an independent determinant of functional outcomes in patients with ICH, and the dynamics of perihemorrhagic edema and its peak volume have been verified to cause secondary injury after ICH. 22,23 Therefore, clot resolution and perihematomal edema are considered therapeutic targets in ICH research. In previous studies, RIC significantly increased the hematoma resolution rate via AMPK-dependent immune regulation and reduced relative perihematomal edema.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of remote ischemic conditioning for spontaneous intracerebral hemorrhage (SERIC-ICH): A multicenter, randomized, parallel-controlled clinical trial study design and protocol

Guo,

Qu,

Abuduxukuer

et al. 2023

European Stroke Journal

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Background: Previous studies have revealed that remote ischemic conditioning (RIC) may have a neuroprotective function. However, the potential benefit of RIC for patients with ICH remain unclear. Objective: The primary aim of this study is to assess the safety and efficacy of RIC for patients with ICH. Methods: The Safety and Efficacy of RIC for Spontaneous ICH (SERIC-ICH) is an ongoing prospective, randomized, multicenter, parallel-controlled, and blinded-endpoint clinical trial. The study will enroll an estimated 2000 patients aged ⩾18 years within 24 h after ICH onset, with National Institutes of Health Stroke Scale ⩾6 and Glasgow Coma Scale ⩾8 upon presentation. The patients will be randomly assigned to the RIC or control groups (1:1) and will be treated with cuffs inflated to a pressure of 200 or 60 mmHg, respectively, twice daily for 7 days. Each RIC treatment will consist of four cycles of arm ischemia for 5 min, followed by reperfusion for another 5 min, for a total procedure time of 35 min. The primary efficacy outcome measure is the proportion of patients with good functional outcomes (modified Rankin scale 0–2) at 180 days. The safety outcome measures will include all adverse events and severe adverse events occurring in the course of the study. Discussion: RIC is an inexpensive intervention and might be a strategy to improve outcomes in patients with ICH. The SERIC-ICH trial will investigate whether RIC treatment can be applied as an adjuvant treatment in the acute phase of ICH and identify safety issues.

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“…86,87 Standardized and automated measurements of PHE have recently been developed but remain poorly validated and difficult to reproduce, limiting their inclusion as eligibility criteria or outcome measures in clinical trials. 88…”

Section: Perihematomal Edemamentioning

confidence: 99%

Prognostic Neuroimaging Biomarkers in Acute Vascular Brain Injury and Traumatic Brain Injury

Krawchuk,

Sharrock

2023

Semin Neurol

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Prognostic imaging biomarkers after acute brain injury inform treatment decisions, track the progression of intracranial injury, and can be used in shared decision-making processes with families. Herein, key established biomarkers and prognostic scoring systems are surveyed in the literature, and their applications in clinical practice and clinical trials are discussed. Biomarkers in acute ischemic stroke include computed tomography (CT) hypodensity scoring, diffusion-weighted lesion volume, and core infarct size on perfusion imaging. Intracerebral hemorrhage biomarkers include hemorrhage volume, expansion, and location. Aneurysmal subarachnoid biomarkers include hemorrhage grading, presence of diffusion-restricting lesions, and acute hydrocephalus. Traumatic brain injury CT scoring systems, contusion expansion, and diffuse axonal injury grading are reviewed. Emerging biomarkers including white matter disease scoring, diffusion tensor imaging, and the automated calculation of scoring systems and volumetrics are discussed.

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Perihematomal Edema and Clinical Outcome After Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis

Cited by 12 publications

References 58 publications

Peri-hematomal edema shape features related to 3-month outcome in acute supratentorial intracerebral hemorrhage

Peri-hematomal edema shape features related to 3-month outcome in acute supratentorial intracerebral hemorrhage

Safety and efficacy of remote ischemic conditioning for spontaneous intracerebral hemorrhage (SERIC-ICH): A multicenter, randomized, parallel-controlled clinical trial study design and protocol

Prognostic Neuroimaging Biomarkers in Acute Vascular Brain Injury and Traumatic Brain Injury

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