Associations of intracranial arterial stenosis and cerebral small vessel diseases with acute ischemic lesions in spontaneous intracerebral hemorrhage

Background and purpose Cerebral small vessel disease (CSVD) has been declared to diffusion-weighted imaging (DWI) lesions in patients with intracerebral hemorrhage (ICH). The impact of large vessel stenosis on stroke remains uncertain. Therefore, this study examines the relationship between CSVD, intracranial arterial stenosis (ICAS), and DWI lesions in patients with ICH. Method A consecutive cohort of 541 patients with spontaneous ICH who had brain MRI and MRA within 14 days of ICH onset was collected and analyzed retrospectively. DWI lesions as well as CSVD were assessed in MRI, and the severity of ICAS was evaluated in MRA. We compared the demographic and clinical features, laboratory parameters, and imaging characteristics of patients with and without DWI lesions and explored the associations of burdens of CSVD and ICAS with DWI lesions in ICH patients using multivariate logistic regression models. Results Of the 541 patients enrolled, 137 (25.3%) presented with DWI lesions. Severe total CSVD burden was significantly associated with DWI lesions (OR 3.56, 95% CI 2.22–5.72, p < 0.001), and a six-point modified CSVD score (OR 4.66, 95% CI 2.86–7.61, p < 0.001) enhanced the prediction of DWI lesions in patients with ICH. Moderate to severe ICAS (OR 2.27, 95% CI 1.39–3.77, p = 0.019) was associated with DWI lesions, which became more significant when moderate to severe ICAS coexisted with moderate total CSVD burden (OR 4.44, 95% CI 1.85–10.69, p = 0.001). Nevertheless, moderate ICAS without CSVD was not linked to DWI lesions in ICH patients. Conclusion Patients with severe CSVD burden are associated with DWI lesions in ICH patients, with a significant correlation also observed between ICAS and DWI lesions. The probability of DWI lesions increases when both ICAS and CSVD are present, suggesting a potential novel association for the development of these lesions.