Abstract Details

Title Influence of Cortical Superficial Siderosis in Patients with Mixed Location Cerebral Microbleeds and Intracerebral Hemorrhage

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S36 - Cerebrovascular Disease and Interventional Neurology: Basic and Translational Science (2:00 PM-2:12 PM)

Poster/Presentation
Number 006

Background HTN-cSVD has been shown to be the predominant microangiopathy in patients with mixed ICH/CMBs.

Objective We aim to test whether the presence of cortical superficial siderosis (cSS), a marker strongly associated with cerebral amyloid angiopathy (CAA), is likely to modify the underlying microangiopathy from hypertensive cerebral small vessel disease (HTN-cSVD) to CAA in patients with a combination of lobar and deep intracerebral hemorrhage (ICH)/cerebral microbleeds (CMBs) (mixed ICH/CMBs).

Design/Methods

Brain MRIs from a prospective database of consecutive non-traumatic ICH patients admitted to a single referral center (2003 to 2019) were reviewed for the presence of CMBs, cSS, and non-hemorrhagic CAA markers (lobar lacunes, centrum semiovale enlarged perivascular spaces (CSO-EPVS), and multispot pattern of leukoaraiosis). The frequency of CAA markers and left ventricular hypertrophy (LVH), a marker for hypertensive end-organ damage, were compared between mixed ICH/CMB patients with cSS (mixed^+cSS) and without cSS (mixed^–cSS) in univariate and multivariate models.

Results

Of 1824 ICH patients, 40 had mixed^+cSSand 256 had mixed^–cSS. LVH was less common in patients with mixed^+cSS compared to those with mixed^–cSS (34% vs. 59%, p = 0.01). The frequency of multispot pattern (18% vs. 4%, p < 0.01) and severe CSO-EPVS (33% vs. 11%, p < 0.01) were higher in patients with mixed^+cSScompared to mixed^–cSS, whereas lobar lacune frequency was similar (23% vs. 20%, p = 0.67). In a logistic regression model, older age (aOR 1.04 per year, 95% CI [1.01–1.08], p = 0.01), presence of multispot pattern (aOR 5.82, 95% CI [1.82–18.60], p < 0.03), severe CSO-EPVS (aOR 4.08, 95% CI [1.73–9.61], p < 0.01), and LVH (aOR 0.43, 95% CI [0.20–0.94], p = 0.03) were independently associated with mixed^+cSS after further adjustment for sex and hypertension.

Conclusions

CAA-related markers are common among patients with mixed ICH/CMBs and cSS, suggesting that CAA may be the underlying microangiopathy in such patients.

Authors/Disclosures
Alvin Das, MD (Beth Israel Deaconess Medical Center) PRESENTER	Dr. Das has nothing to disclose.
Elif Gokcal	No disclosure on file
Alessandro Biffi, MD (Eli Lilly and Company)	Dr. Biffi has received personal compensation for serving as an employee of Eli Lilly And Company. Dr. Biffi has stock in Eli Lilly And Company.
Robert W. Regenhardt, MD, PhD (Massachusetts General Hospital)	Dr. Regenhardt has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Rapid Medical. Dr. Regenhardt has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Johnson and Bell Trial Lawyers. The institution of Dr. Regenhardt has received research support from National Institutes of Health. The institution of Dr. Regenhardt has received research support from Society of Vascular and Interventional Neurology. The institution of Dr. Regenhardt has received research support from Heitman Foundation.
Avia Abramovitz	Ms. Abramovitz has nothing to disclose.
Anand Viswanathan, MD (Massachusetts General Hospital)	Dr. Viswanathan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alnylam Pharmaceuticals. Dr. Viswanathan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Viswanathan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche Pharmaceuticals.
W. T. Kimberly, MD, PhD (Massachusetts General Hospital)	Dr. Kimberly has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Astrocyte Pharmaceuticals. Dr. Kimberly has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Acasti Pharma. Dr. Kimberly has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Hyperfine Inc.. Dr. Kimberly has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurotherapeutics. Dr. Kimberly has stock in Woolsey Pharmaceuticals. Dr. Kimberly has stock in Acasti Pharma. The institution of Dr. Kimberly has received research support from Biogen. The institution of Dr. Kimberly has received research support from NControl Therapeutics. The institution of Dr. Kimberly has received research support from NIH. The institution of Dr. Kimberly has received research support from American Heart Association. The institution of Dr. Kimberly has received research support from Hyperfine, Inc.. Dr. Kimberly has received intellectual property interests from a discovery or technology relating to health care.
Joshua Goldstein (Massachusetts General Hospital)	Joshua Goldstein has received personal compensation in the range of $500-$4,999 for serving as a Consultant for CSL Behring. Joshua Goldstein has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Portola. Joshua Goldstein has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Ncontrol. The institution of Joshua Goldstein has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Octapharma. Joshua Goldstein has received stock or an ownership interest from NControl. The institution of Joshua Goldstein has received research support from Pfizer. The institution of Joshua Goldstein has received research support from Takeda.
Lee H. Schwamm, MD, FAAN (Yale New Haven Health System)	Dr. Schwamm has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Prime Education. Dr. Schwamm has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Schwamm has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for lifeimage. Dr. Schwamm has received personal compensation in the range of $500-$4,999 for serving as a Consultant for mediasphere. Dr. Schwamm has received personal compensation in the range of $500-$4,999 for serving as a Consultant for medscape/WebMD. Dr. Schwamm has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for medtronic. Dr. Schwamm has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Penumbra. Dr. Schwamm has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. The institution of Dr. Schwamm has received research support from NINDS. The institution of Dr. Schwamm has received research support from PCORI. Dr. Schwamm has received intellectual property interests from a discovery or technology relating to health care. An immediate family member of Dr. Schwamm has received publishing royalties from a publication relating to health care. Dr. Schwamm has a non-compensated relationship as a Board of directors with American heart association that is relevant to AAN interests or activities.
Jonathan Rosand, MD (Massachusetts General Hospital)	Dr. Rosand has received personal compensation for serving as an employee of Massachusetts General Hospital. Dr. Rosand has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eli Lilly and Co. Dr. Rosand has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. Dr. Rosand has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for National Football League. The institution of Dr. Rosand has received research support from NIH. The institution of Dr. Rosand has received research support from American Heart Association. Dr. Rosand has received personal compensation in the range of $0-$499 for serving as a Peer reviewer with National Institutes of Health. Dr. Rosand has a non-compensated relationship as a Trustee with Columbia University that is relevant to AAN interests or activities.
Steven M. Greenberg, MD, PhD, FAAN	Dr. Greenberg has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eli Lilly. Dr. Greenberg has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Washington University/IQVIA. Dr. Greenberg has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bayer. Dr. Greenberg has received research support from National Institutes of Health. Dr. Greenberg has received publishing royalties from a publication relating to health care.
Edip M. Gurol, MD (Massachusetts General Hospital)	The institution of Dr. Gurol has received research support from NIH/NINDS. The institution of Dr. Gurol has received research support from Boston Scientific Corporation. The institution of Dr. Gurol has received research support from AVID (a wholly owned subsidiary of Eli Lilly). The institution of Dr. Gurol has received research support from Pfizer.