Abstract WP236: Impact of Cerebral Small Vessel Disease on Outcomes After Acute Intracerebral Hemorrhage

Background: The prognostic implication of small vessel disease (SVD) features in sporadic intracerebral hemorrhage (ICH) remains uncertain. Objective: To evaluate prognostic value of both individual SVD features—white matter hyperintensities (WMH), including periventricular hyperintensities (PVH) and deep white matter hyperintensities (DWMH), lacunes, and cerebral microbleeds (CMBs)—and SVD burden on functional outcomes after ICH. Methods: We utilized data from a single-center prospective registry, which consecutively enrolled patients diagnosed with acute ICH between January 2011 and December 2022. SVD was assessed primarily on MRI obtained on the day of onset; if unavailable, the MRI obtained on the closest day was used. SVD features were rated according to the criteria of STRIVE. We rated the total SVD score by counting the presence of each SVD feature (lacune, CMBs, PVH [Fazekas score≥3], and DWMH [Fazekas score≥2]). The primary outcome was poor functional and vital status at 90 days, defined as a modified Rankin Scale (mRS) score ≥4. Multivariable logistic regression was adjusted for age, sex, ICH location (lobar/deep/infratentorial), admission NIHSS, hematoma volume, and intraventricular extension. Results: Of 2,322 consecutive patients, 1,851 patients (median age 72 years, female 43%) underwent MRI, and poor outcome was observed in 913 (49.3%). Baseline characteristics included premorbid mRS (median 0 [IQR 0–1]), ICH location (lobar 23.2%, deep 62.9%, infratentorial 13.9%), admission NIHSS (median 13 [IQR 5–23]), hematoma volume (median 12.5 mL [IQR 4.8–32.5]), and intraventricular extension in 35.5%. Baseline distributions of SVD features and the SVD score are shown in Table 1. The SVD score showed a median of 2 [IQR 1–3]. In multivariable analyses, WMH burden was each associated with higher odds of poor outcome (PVH grade 3 vs 0: OR 2.42, 95% CI 1.25–4.68, DWMH grade 3 vs 0: OR 2.34, 95% CI 1.24–4.43). Neither lacunes nor deep or lobar CMB were significantly associated with the outcome. In contrast, the highest SVD score category was significantly associated with the outcome (4 vs 0: OR 2.76, 95% CI 1.55–4.93). Conclusions: WMH and SVD burden show a positive relationship with disability or death after ICH, underscoring their potential utility in informing prognosis and guiding post-stroke care.