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Developing an algorithm to identify patients with intracerebral haemorrhage secondary to a macrovascular cause.


ABSTRACT:

Introduction

Determining the cause of spontaneous (non-traumatic) intracerebral haemorrhage (ICH) is critical to guide treatment and prognosis. We investigated whether small vessel disease (SVD) in addition to clinical and other radiological findings on acute neuroimaging predicts a low risk of a macrovascular cause (e.g. an arterio-venous malformation, aneurysm or dural arteriovenous fistula).

Patients and methods

We identified patients with acute spontaneous ICH who underwent acute non-contrast CT, CT angiography (CTA) and intra-arterial digital subtraction angiography (IADSA) at our institution from January 2010 to April 2014. Logistic regression including CTA result, SVD, age, pre-ICH hypertension and ICH location was used to derive a prediction model, validated using bootstrapping.

Results

173 patients (46% female, median age 49) of whom 78 had a macrovascular cause on IADSA were included. Predictors of a macrovascular cause were: abnormal CTA (OR 67.4; p?p?=?0.019); and absence of pre-ICH hypertension (OR 3.4; p?=?0.05). In our internally derived prediction model, the combination of CTA, SVD and pre-ICH hypertension predicted the likelihood of an underlying macrovascular cause (optimism-adjusted ROC area 0.919). Patients with negative CTA, SVD and pre-ICH hypertension have a low likelihood of an underlying macrovascular cause (1.8%).

Discussion and conclusion

A combination of CTA, SVD and pre-ICH hypertension predict the likelihood of finding a macrovascular cause in patients with acute spontaneous ICH, allowing informed decisions regarding the likely benefit and risk of IADSA.

SUBMITTER: Wilson D 

PROVIDER: S-EPMC6453186 | biostudies-literature | 2017 Dec

REPOSITORIES: biostudies-literature

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Publications

Developing an algorithm to identify patients with intracerebral haemorrhage secondary to a macrovascular cause.

Wilson Duncan D   Ogungbemi Ayokunle A   Ambler Gareth G   Jones Ifan I   Werring David J DJ   Jäger Hans R HR  

European stroke journal 20170919 4


<h4>Introduction</h4>Determining the cause of spontaneous (non-traumatic) intracerebral haemorrhage (ICH) is critical to guide treatment and prognosis. We investigated whether small vessel disease (SVD) in addition to clinical and other radiological findings on acute neuroimaging predicts a low risk of a macrovascular cause (e.g. an arterio-venous malformation, aneurysm or dural arteriovenous fistula).<h4>Patients and methods</h4>We identified patients with acute spontaneous ICH who underwent ac  ...[more]

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