From the Guidelines
Cerebral amyloid angiopathy (CAA) is a condition characterized by the deposition of β-amyloid peptide in the walls of arterioles and capillaries in the leptomeninges, cerebral cortex, and cerebellar hemispheres, primarily affecting older adults and those with apolipoprotein E genotypes containing the ε2 or ε4 alleles 1.
Key Characteristics of CAA
- CAA is defined by the deposition of β-amyloid peptide in the walls of arterioles and capillaries in the leptomeninges, cerebral cortex, and cerebellar hemispheres 1.
- The primary risk factors for CAA are age and apolipoprotein E genotypes containing the ε2 or ε4 alleles 1.
- CAA typically occurs in lobar territories, as opposed to arteriolosclerosis which occurs in deep territories 1.
Diagnosis and Management
- Diagnosis of CAA typically involves brain imaging such as MRI to detect microbleeds and white matter changes characteristic of CAA.
- Management of CAA focuses on controlling blood pressure, avoiding blood thinners when possible, treating symptoms, and preventing complications 1.
- Patients with CAA should maintain regular follow-ups with neurologists to monitor disease progression and adjust management strategies as needed.
Current Research and Future Directions
- Research is ongoing for potential treatments targeting amyloid protein accumulation, which may eventually provide more direct therapeutic options.
- Currently, there is no specific treatment to remove amyloid deposits, highlighting the need for continued research and development of effective therapies 1.
From the Research
CAA Brain
- Cerebral amyloid angiopathy (CAA) is a cerebral small vessel disease associated with brain haemorrhage and cognitive change 2
- The commonest form of CAA, sporadic amyloid-β CAA, usually affects people in mid- to later life, but early-onset forms are increasingly recognized 2
- Early-onset CAA may result from genetic or iatrogenic causes, and improving awareness of these unusual forms amongst healthcare professionals is essential for facilitating prompt diagnosis 2
Related Conditions
- Carotid atherosclerotic disease is an important contributor to ischemic stroke risk, and management is impacted by whether there are associated symptoms along with the degree of stenosis 3
- Aspirin is widely used as an antiplatelet agent for secondary prevention in patients with atherosclerotic cardiovascular disease, but its use in primary prevention is controversial 4, 5
- Anticoagulation may exacerbate possible tendencies for an ischemic infarction to become hemorrhagic, and caution is advised when using anticoagulation immediately following aspirin therapy in patients with cerebral infarction 6
Treatment and Management
- Carotid intervention for symptomatic high-grade carotid stenosis is best managed with intervention either by carotid endarterectomy or carotid stenting 3
- Asymptomatic carotid stenosis is the subject of considerable controversy in terms of optimal management, and the choice to use aspirin should be made only after careful estimate of the individual's CV-and hemorrhagic risk 5
- Low-dose aspirin may slightly alleviate the progression of carotid intima-media thickness (cIMT) in patients with asymptomatic carotid atherosclerosis, but does not reduce vascular events and all-cause death 4