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Abstract Details

The Use and Yield of Vascular Imaging in Patients with Deep Intracerebral Hemorrhage
Neuro Trauma, Critical Care, and Sports Neurology
P3 - Poster Session 3 (5:30 PM-6:30 PM)
4-003
To identify factors associated with (1) utilization and (2) diagnostic yield of vascular imaging for deep ICH.
Although the most common etiology for deep intracerebral hemorrhage (ICH) is hypertension, practitioners frequently order vascular imaging to rule out vascular pathology.  It is important to clarify the diagnostic utility of vascular imaging in deep ICH. 
We retrospectively reviewed the utilization and yield of vascular imaging for patients with deep ICH at three academic medical centers. 

Of 118 patients with deep ICH, 55 (47%) had vascular imaging as part of their workup (37 (67%) had a CTA, 24 (44%) had catheter angiography and 10 (39%) had an MRA). In 7/55 patients (13%), vascular imaging identified bleed etiology (3 arteriovenous malformations, 1 developmental venous anomaly, 1 reversible cerebral vasoconstriction syndrome, 1 Moya Moya, and 1 vasculitis).  The use of vascular imaging was significantly higher in patients who (1) were younger (61 ± 14 vs. 71 ± 13; P<0.001), (2) had lower NIHSS (median  (IQR) of 8 (3-17) vs. 14 (5-27); P=0.017), (3) had smaller bleeds (median (IQR) of 6cc (3-23) vs. 14cc (5-37); P=0.033) and (4) had lower ICH score (median (IQR) of 1 (0-2) vs. 2 (1-3); P=0.046). Patients who had vascular imaging that helped explain ICH etiology were more likely to (1) have no history of hypertension (36% vs. 7%; P=0.02), 2) have lower blood pressure on admission (median (IQR) of 138mm Hg (119-153) vs. 158mm Hg (144-209); P=0.04), and (3) be younger (53 ± 14 vs. 62 ± 14; P=0.13). There was no significant relationship between vascular imaging use or yield and sex, race, smoking history, or history of ICH. 

 
Performance of vascular imaging should be considered to workup bleed etiology in select patients with deep ICH who do not have a history of hypertension and are not hypertensive on presentation. 
Authors/Disclosures
Luke Moretti
PRESENTER 		The institution of Mr. Moretti has received research support from the NIH.
Jennifer A. Frontera, MD (NYU Langone Health) Dr. Frontera has received personal compensation in the range of $500-$4,999 for serving as a Consultant for FirstKindMedical. Dr. Frontera has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Physician 好色先生 Resource. The institution of Dr. Frontera has received research support from NIH. The institution of Dr. Frontera has received research support from Alexion. Dr. Frontera has received publishing royalties from a publication relating to health care.
Aaron Lord, MD (NYU Langone-Brooklyn) Dr. Lord has nothing to disclose.
Jose L. Torres, MD (NYU) Dr. Torres has nothing to disclose.
Koto Ishida, MD, FAAN (NYU) Dr. Ishida has received publishing royalties from a publication relating to health care.
Barry M. Czeisler, MD, MS, MHPE, FAAN (Providence Specialty Medical Group) Dr. Czeisler has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for NeuroStat Consulting LLC. Dr. Czeisler has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for NeuroStat Consulting LLC. Dr. Czeisler has stock in Brainspace. Dr. Czeisler has received publishing royalties from a publication relating to health care.
Ariane Lewis, MD, FAAN (NYU Langone Medical Center) Dr. Lewis has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Seminars in Neurology. Dr. Lewis has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of Clinical Neuroscience.