Cerebral Angiography Impacts Risk Factors for Diffusion-weighted Imaging Lesions in Patients After Minimally Invasive Surgery for Intracerebral Hemorrhage

Introduction: Diffusion-weighted imaging (DWI) lesions have been linked to poor outcomes after intracerebral hemorrhage (ICH). We sought to assess the impact of cerebral angiography on predictors of DWI lesions in patients undergoing minimally invasive surgery (MIS) for ICH.

Methods: Retrospective chart review was performed on ICH patients treated with MIS in a single health system from 2015 to 2021. Postoperative MRIs of 170 patients were reviewed. The cohort was bisected by angiogram history. Univariate analyses were conducted to determine predictors of DWI lesions and variables with p≤0.05 were included in multivariate analyses.

Results: DWI lesions were present in 88 (52%) patients who underwent MIS for ICH. Of the 83 patients who underwent angiography, 56 (67%) patients demonstrated DWI lesions. In the angiography cohort, age (OR 1.86 per decade, 95% CI 1.08-3.49, p=0.035), severe leukoaraiosis (OR 6.27 for Fazekas score ≥3, 95% CI 1.34-46.80, p=0.035), preoperative hematoma volume (OR 1.41 per 10 mL, 95% CI 1.09-1.98, p=0.023), and presenting National Institutes of Health Stroke Score (NIHSS) (OR 1.61 per 4 units, 95% CI 1.09-2.52, p=0.024) were predictive of DWI lesions. Of the 87 patients who did not undergo angiography, 32 (37%) patients demonstrated DWI lesions. In the non-angiography cohort, presenting systolic blood pressure (SBP) (OR 1.31 per 10 mmHg above 140 mmHg, 95% CI 11.09-1.62 p=0.007), intraventricular hemorrhage (IVH) (OR 5.81, 95% CI 1.75-21.71, p=0.005), and NIHSS (OR 1.83 per 4 units, 95% CI 1.17-3.11, p=0.014) were predictive of DWI lesions.

Conclusion : We demonstrate that preprocedural angiography impacts risk factors for DWI lesions after MIS for ICH. At our institution, we have developed stricter criteria for patients to undergo cerebral angiography before MIS for ICH.