Abstract Body: Background & Aims: Intraventricular extension (IE) is associated with unfavorable prognosis among patients with intracerebral hemorrhage (ICH). However, factors associated with IE are unknown. We aimed to elucidate the relation between IE and small vessel disease (SVD) in ICH.
Methods: Consecutive patients with acute ICH admitted between July 2012 and November 2023 were retrospectively screened using Kagoshima Medical Center Stroke Database. The inclusion criteria were as follows: 1) onset to door time within 7 days; 2) availability of SVD evaluation using total SVD score on MRI; and 3) availability of IE evaluation on admission and more than 24 hours after admission on CT. Total SVD score was calculated as the sum of points for each of the following four imaging findings (each scored as 1 point, maximum score 4): 1 or more old lacunes, the presence of white matter hyperintensity (periventricular: Fazekas grade 3 and/or deep white matter: Fazekas grade 2–3), 1 or more cerebral microbleeds, and 11 or more basal ganglia enlarged perivascular spaces. We investigated the association between SVD burden and IE by performing Poisson regression analyses with a robust variance estimator adjusted by sex, age, excessive alcohol intake, use of antiplatelet drugs and anticoagulants before admission, hypertension, body mass index, hemorrhage location, and hemorrhage size.
Results: We screened 608 consecutive ICH patients. Of them, 449 were identified (234 [52%] males, median age 75 years). IE was observed in 151 patients (34%). In multivariable analysis, total SVD score was independently associated with IE (prevalence ration (PR) 1.188, 95% CI 1.063-1.329, p = 0.002, Figure 1). Further, a positive linear trend was observed between total SVD score and IE in reference to total SVD score 0 (total SVD score 0: PR 1.000, total SVD score 1-2: PR 3.769, total SVD score 3-4: PR 4.109, p = 0.011 for trend, Figure 2). Finally, among the four items comprising the total SVD score, white matter hyperintensity (PR 1.406 95% CI 1.041-1.899, p = 0.026, Figure 3) and cerebral microbleeds (PR 1.800, 95% CI 1.068-3.036, p = 0.027, Figure 3) were associated with IE.
Conclusions: In acute ICH patients, higher total SVD score was associated with IE even after adjusted by risk factors for ICH, hemorrhage location, and hemorrhage size. Especially, white matter hyperintensity and cerebral microbleeds may have effects on the incidence of IE.