Objective:

Background:

There is limited understanding of the difference between hemorrhagic and non-hemorrhagic type of cerebral amyloid angiopathy (CAA), but there are significant differences in their clinical course and impact on prognosis.

Design/Methods:

Patients consecutively enrolled in the national multicenter prospective "Cerebral Small Vessel Disease Cohort Study" from March 2017 to May 2022 who met the Boston diagnostic criteria for CAA or CAA-related inflammation were selected. Demographic data, apolipoprotein E(APOE) genotype, cranial magnetic resonance imaging including gradient echo sequence and laboratory data were collected. Patients with a past/present medical history of non-traumatic symptomatic ICH were classified as hemorrhagic type after exclusion of other etiologies.

Results:

A total of 219 CAA patients were included, with an average age of 67.12±9.93. 62.6% were male, and 26.0% were hemorrhagic CAA patients. Univariate analysis showed that there were differences between CAA hemorrhagic and non-hemorrhagic groups in terms of carrying APOE ε 2 allele, carrying APOE ε4 allele, number of lobar microbleeds, Fazekas grade, gait disorder, mood change, bulbar paralysis, onset, history of hypertension, blood pressure control, antiplatelet therapy and modified Rankin scale score between CAA hemorrhagic group and non-hemorrhagic group (P < 0.1). Logistic regression analysis showed that carrying APOE ε 2 allele and the number of lobar microbleeds is associated with hemorrhagic CAA (P < 0.05).

Conclusions:

It is meaningful and necessary to classify hemorrhagic or non-hemorrhagic CAA. When patients have comorbidities and require antithrombotic therapy, it is particularly important to identify patients with high bleeding risk and reduce antithrombotic intensity. CAA-ICH patients are more often carrying APOE ε2 allele and a relatively small number of microbleeds, thus antithrombotic therapy should be carefully selected for CAA patients with such characteristics.