Interaction between cerebral small vessel disease, blood pressure, and remote ischemic lesions in acute spontaneous intracerebral hemorrhage.

Content Provider	Europe PMC
Author	Chen, Szu-Ju Tsai, Hsin-Hsi Lo, Yen-Ling Chen, Ya-Fang Tang, Sung-Chun Jeng, Jiann-Shing Tsai, Li-Kai
Copyright Year	2023
Abstract	Background: Acute blood pressure (BP) reduction is the first-line treatment for acute spontaneous intracerebral hemorrhage (ICH); however, recent research suggests that intensive BP reduction along with cerebral small vessel disease (cSVD) is a risk factor for remote DWI lesions (RDWILs). We aimed to delineate the interplay between cSVD and BP reduction therapy on the risk of RDWILs. Methods: We enrolled 303 patients who underwent brain magnetic resonance imaging within 7 days after acute spontaneous ICH. RDWILs were categorized as occurring in borderzone (BZ) or non-BZ areas. We examined the effect of cSVD, acute BP reduction, and their interaction on RDWILs. Results: RDWILs were observed in 34 (11%) patients (59.8 ± 10.3-years-old, 24% male). RDWILs were associated with a larger acute weighted average mean arterial pressure (MAP) reduction in the initial 24 h after ICH onset and a higher total cerebral microbleed (CMB) count. Intensive MAP changes (odds ratio (OR) per 10 mmHg 1.76, 95% confidence interval (CI) 1.03–3.20), total CMBs burden (OR per 10 CMBs 1.21, 95% CI 1.08–1.39), and presence of lobar CMBs (OR 7.33, 95% CI 1.59–55.6) were risk factors for RDWILs at BZ, but not at non-BZ. Furthermore, a significant interaction was observed between lobar CMBs and MAP reduction on increased risk of RDWILs at BZ (p = 0.030). Conclusion: cSVD modulates the effect of acute BP reduction on the risk of RDWILs. Patients with extensive microangiopathy have a higher risk of developing cerebral ischemic changes in BZ during unstable hemodynamic status.
Related Links	https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC10472944&blobtype=pdf
ISSN	23969873
Volume Number	8
DOI	10.1177/23969873231170989
PubMed Central reference number	PMC10472944
Issue Number	3
PubMed reference number	37641548
Journal	European Stroke Journal [Eur Stroke J]
e-ISSN	23969881
Language	English
Publisher	SAGE Publications
Publisher Date	2023-04-20
Publisher Place	Sage UK: London, England
Access Restriction	Open
Rights License	© European Stroke Organisation 2023
Subject Keyword	Blood pressure cerebral small vessel disease magnetic resonance imaging intracerebral hemorrhage remote DWI lesion
Content Type	Text
Resource Type	Article
Subject	Neurology (clinical) Cardiology and Cardiovascular Medicine