AUTHOR=Xu Mangmang , Li Baojin , Zhong Di , Cheng Yajun , Wu Qian , Zhang Shuting , Zhang Shihong , Wu Bo , Liu Ming 

TITLE=Cerebral Small Vessel Disease Load Predicts Functional Outcome and Stroke Recurrence After Intracerebral Hemorrhage: A Median Follow-Up of 5 Years

JOURNAL=Frontiers in Aging Neuroscience

VOLUME=Volume 13 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/aging-neuroscience/articles/10.3389/fnagi.2021.628271

DOI=10.3389/fnagi.2021.628271

ISSN=1663-4365

ABSTRACT=Background: Uncertainty exists over long-term prognostic significance of cerebral small vessel disease (CSVD) in primary intracerebral hemorrhage (ICH). 
Methods: We performed a longitudinal analysis of CSVD and clinical outcomes in consecutive patients with primary ICH who had MRIs. Baseline CSVD load (including white matter hyperintensities [WMH], cerebral microbleeds [CMBs], lacunes, and enlarged perivascular spaces [EPVS]) were evaluated. Cumulative CSVD score was calculated by combining the presence of each CSVD marker (range 0–4). We followed participants for poor functional outcome (mRS≥4), stroke recurrence, and time-varying survival during a median follow-up of 4.9 (IQR 3.1-6.0) years. Parsimonious and fuller multivariable logistic-regressions and Cox-regression analyses were performed to estimate the association of CSVD markers, individually and collectively, with each outcome. 
Results: A total of 153 patients were included in the analyses. CMBs≥10 (adjusted OR [adOR] 3.252, 95% CI 1.181-8.956, p=0.023) and periventricular WMH (PWMH) (adOR 2.053, 95% CI 1.220-3.456, p=0.007) were significantly associated with poor functional outcome. PWMH (adOR 2.908, 95% CI 1.230-6.878, p=0.015) and lobar CMB severity (adOR 1.811, 95% CI 1.039-3.157, p=0.036) were associated with stroke recurrence. Cumulative CSVD score was associated with poor functional outcome (adOR 1.460, 95% CI 1.017-2.096) and stroke recurrence (adOR 2.258, 95% CI 1.080-4.723). Death occurred in 36.1% (13/36) of patients with CMBs≥10 compared with 18.8% (22/117) in those with CMB<10 (adjusted HR 2.669, 95% CI 1.248-5.707, p=0.011). In addition, cumulative CSVD score≥2 was associated with a decreased survival rate (adjusted HR 3.140, 95% CI 1.066-9.250, p=0.038). 
Conclusions: Severe PWMH, CMB or cumulative CSVD burden exert important influences on the long-term outcome of ICH.