Location‐Specific Hematoma Volume Tolerance for Spontaneous Intracerebral Hemorrhage: A Pooled Analysis of INTERACT2 and ATACH II

作者：Vincent Brissette, Menglu Ouyang, Vignan Yogendrakumar, Tim Ramsay, Ranjeeta Mallick, Andrea Morotti, Joshua N. Goldstein, Adnan I. Qureshi, Craig S. Anderson, Dar Dowlatshahi · 发表于：Journal of the American Heart Association · 年份：2026 · DOI：10.1161/jaha.125.049096 · 研究领域：Intracerebral and Subarachnoid Hemorrhage Research、Traumatic Brain Injury and Neurovascular Disturbances、Acute Ischemic Stroke Management

BACKGROUND: Location-specific hematoma-volume thresholds are potentially important for prognostication and surgical decisions in acute intracerebral hemorrhage. We aimed to define this metric in relation to poor functional outcome in a pooled individual patient-level data analysis of 2 large intracerebral hemorrhage clinical trials: ATACH II (Antihypertensive Treatment of Acute Cerebral Hemorrhage) and INTERACT2 (Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial). METHODS: Final hematoma volumes were measured using planimetric analysis of 24-hour computed tomography in relation to hematoma location stratified by basal ganglia, thalamus, and lobar regions. Volume thresholds in 5-mL increments to >50 mL and Youden's index were used to identify optimal thresholds associated with poor outcome (modified Rankin Scale scores, 4-6) and death at 3 months. Multivariable logistic regression was used to estimate adjusted odds ratio models within each location. RESULTS: There were 1691 patients included in these analyses, with 919 (54.3%), 551 (32.6%), and 221 (13.1%) located in the basal ganglia, thalamus, and lobar regions, respectively. Using Youden's index, location-specific hematoma volume thresholds (mL) that were most predictive of poor outcome were: 22.24 for basal ganglia (sensitivity, 0.57; specificity, 0.84; adjusted odds ratio, 4.82 [95% CI, 3.19-7.27]), 8.13 for thalamus (sensitivity, 0.68; specificity, 0.75; adjusted odds ratio, 2.73 [95% CI, 1.62-4.59]),...