INTRODUCTION Intracerebral hemorrhage (ICH) is the most severe subtype of stroke. Its mortality rate is high, and most survivors experience significant disability. OBJECTIVE To assess primary patient risk factors associated with mortality and neurologic disability 3 months after ICH in a large, racially and ethnically balanced cohort. DESIGN, SETTING, AND PARTICIPANTS This cohort study included participants from the Ethnic/ Racial Variations of Intracerebral Hemorrhage (ERICH) study, which prospectively recruited 1000 non-Hispanic White, 1000 non-Hispanic Black, and 1000 Hispanic patients with spontaneous ICH to study the epidemiological characteristics and genomics associated with ICH. Participants included those with uniform data collection and phenotype definitions, centralized neuroimaging review, and telephone follow-up at 3 months. Analyses were completed in November 2021. EXPOSURES Patient demographic and clinical characteristics as well as hospital event and imaging variables were examined, with characteristics meeting P < .20 considered candidates for a multivariate model. Elements included in the ICH score were specifically analyzed. MAIN OUTCOMES AND MEASURES Individual characteristics were screened for association with 3-month outcome of neurologic disability or mortality, as assessed by a modified Rankin Scale (mRS) score of 4 or greater vs 3 or less under a logistic regression model. A total of 25 characteristics were tested in the final model, which minimized the Akaike information criterion. Analyses were repeated removing individuals who had withdrawal of care. RESULTS A total of 2568 patients (mean [SD] age, 62.4 [14.7] years; 1069 [41.6%] women and 1499[58.4%] men) had a 3-month outcome determination available, including death. The final logistic model had a significantly higher area under the receiver operating characteristics curve (C = 0.88) compared with ICH score alone (C = 0.76; P < .001). Among characteristics associated with neurologic disability and mortality were larger log ICH volume (OR, 2.74; 95% CI, 2.36-3.19; P < .001),

Background: Successful recanalization and good collateral status are associated with good clinical outcome in patients with acute ischemic stroke treated with endovascular treatment, but the relationships among them are unclear. Methods: We analysed data from the MR CLEAN Registry, a multicenter prospective cohort study of patients with acute ischemic stroke who underwent endovascular treatment in the Netherlands. Collateral status was assessed using a common 4-point visual grading scale. Successful recanalization was defined as an extended Thrombolysis in Cerebral Infarction score ≥ 2B. Functional outcome at 90 days was determined with the modified Rankin Scale score. We assessed, in multivariable (ordinal) logistic regression models, the associations between 1) collateral status and successful recanalization, 2) successful recanalization and functional outcome, 3) collateral status and functional outcome. An interaction term (successful recanalization*collateral grade) was added to the latter model, to assess effect modification. Subgroup analyses were performed for patients treated with intravenous thrombolysis. Results: We included 2717 patients, 1898 (70%) with successful recanalization. There was no relationship between collateral status and successful recanalization. Successful recanalization (acOR 2.15, 95% CI 1.84-2.52) and better collateral grades (Grade 1, acOR 2.12, 95% CI 1.47-3.05; Grade 2, acOR 3.46, 95% CI 2.43-4.92; Grade 3, acOR 4.16, 95% CI 2.89-5.99) were both associated with a shift towards better functional outcome. There was no significant interaction between collateral status and successful recanalization. Results were similar for patients treated with intravenous thrombolysis. Conclusions: Collateral status is not associated with the probability of successful recanalization after endovascular treatment and does not modify the association between successful recanalization and functional outcome.

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Background: In patients with ischemic stroke undergoing endovascular treatment (EVT), time to treatment and collateral status are important prognostic factors. We assessed the relation between time to CT angiography (CTA) and collateral status. Furthermore, we assessed whether collateral status modifies the relationship between onset to recanalization time (ORT) and functional outcome. Methods: From the prospective, multicenter MR CLEAN Registry, we included patients with acute ischemic stroke, who had a carotid terminus or M1 occlusion and were treated with EVT in the Netherlands within 6.5 hours of symptom onset. A quantitative collateral score (qCS) was assessed from baseline CTA using an automated image analysis algorithm (Strokeviewer; Nico.lab). Multivariable regression models were used to assess the relationship between time to imaging and the qCS and between ORT and functional outcome (90-day modified Rankin Scale score). An interaction term (ORT * qCS) was introduced in the latter model to test whether qCS modifies this relation. Results: We analysed 1813 patients. The median time from symptom onset to CTA was 91 minutes [IQR: 56-150] and the median qCS was 49% [IQR: 25-79]. Longer time to CTA was not associated with qCS (β per 30 minutes, 0.001 [-0.008 - 0.010]). Both a higher qCS (acOR per 10% increase, 1.07 [1.03-1.10], p<0.001) and shorter ORT (acOR per 30 minutes, 1.17 [1.13-1.21], p<0.001) were independently associated with a shift towards better functional outcome. The qCS did not modify the relationship between ORT and functional outcome (p for interaction: 0.28; Figure). Conclusions: In patients with ischemic stroke caused by carotid-terminus or M1 occlusion presenting within 6.5 hours of symptom onset, the collateral status is unaffected by time to CTA and the benefit of a shorter ORT is similar across the entire range of collateral scores.

Introduction: Intracerebral hemorrhage (ICH) is the most severe subtype of stroke with a high mortality rate and majority of survivors suffering significant disability. The Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study prospectively recruited 1000 white, 1000 black and 1000 Hispanic spontaneous ICH cases. Herein, we report the main results of the predictors of 3 month outcome after ICH. Hypothesis: We hypothesized that ICH Score variables of age, ICH volume, ICH location, presence of intraventricular hemorrhage (IVH), and presenting Glasgow Coma Scale would predict long-term disability in addition to prior validation of mortality. Methods: Between 2010-2015, cases were prospectively recruited with uniform phenotype definitions, centralized neuroimaging review and with telephone follow-up at 3 months. Apolipoprotein E genotyping was performed centrally. Individual characteristics were screened for association under a logistic regression model, 90-day mRS ≥ 4 versus 0-3, and those meeting P<0.2 were entered into multivariate model building where the final model was determined by minimum AIC score. Analyses were repeated removing subjects with withdrawal of care. Results: The Table presents the prevalence/average of each variable entering the final multivariate model for association with poor (mRS 4-6) compared to good (mRS 0-3) outcome at 3 months. When analyses were repeated excluding withdrawal of care, overall Graeb (IVH) score fell out of the model (with presence of IVH replacing it) but the remaining variables were retained and in the same direction of effect. C-statistic for the multivariate model = 0.884 compared to 0.763 for ICH score alone (p=1.7E-22). Conclusion: ICH score elements were validated as predictive of 3 month outcome. Novel baseline characteristics such as white matter hyperintensity as well as subsequent clinical events that may affect outcomes were identified. Location specific results to be presented.