From the Guidelines
Treatment for amyloid angiopathy should focus on managing symptoms and preventing complications, with a primary approach of controlling blood pressure to reduce bleeding risk, and avoiding anticoagulants and antiplatelet agents whenever possible. The goal is to minimize the risk of intracerebral hemorrhage, which is the most serious complication of amyloid angiopathy, while managing associated symptoms and preserving quality of life 1. Key considerations include:
- Controlling blood pressure with a target below 130/80 mmHg using medications like ACE inhibitors or ARBs, but with caution due to the risk of hypotension in patients with cardiac amyloidosis 1
- Avoiding anticoagulants such as warfarin and direct oral anticoagulants, as well as antiplatelet agents like aspirin, unless absolutely necessary for other conditions 1
- Using anticonvulsants like levetiracetam for patients who experience seizures due to CAA-related hemorrhages, and cholinesterase inhibitors like donepezil for cognitive symptoms
- Regular neurological monitoring with MRI scans every 1-2 years to track disease progression
- Lifestyle modifications, including smoking cessation, limited alcohol consumption, and regular physical activity within safe parameters It's essential to weigh the benefits of anticoagulation against the potential increased risk of bleeding in patients with amyloid angiopathy, and to consider the individual patient's risk factors and medical history when making treatment decisions 1.
From the Research
Treatment of Amyloid Angiopathy
There are several approaches to treating amyloid angiopathy, including:
- Managing the risk of intracerebral hemorrhage, which is a major complication of the disease 2, 3
- Avoiding anticoagulation in patients with cerebral amyloid angiopathy (CAA) and atrial fibrillation, especially those with a history of lobar intracerebral hemorrhage or cortical microbleeds 2
- Using alternative treatments to anticoagulation, such as left atrial appendage closure, in patients with CAA and atrial fibrillation 3
- Identifying and managing CAA-related inflammation, which can be treated with immunosuppressive therapy in the acute phase 3
Diagnostic Criteria and Imaging Biomarkers
Diagnostic criteria and imaging biomarkers play a crucial role in managing CAA, including:
- Cortical microbleeds, cortical superficial siderosis, convexal subarachnoid hemorrhage, and lobar intracerebral hemorrhage as biomarkers for CAA severity 2, 3
- Quantifying the risk of ischemic and hemorrhagic stroke using scores such as CHA2DS2-VASc 2
Emerging Therapeutic Strategies
Emerging therapeutic strategies for CAA include:
- Targeting key molecules involved in Aβ cytotoxicity, Aβ fibril formation, and vessel wall remodeling, such as apolipoprotein E, clusterin, and SRPX1 4
- Developing effective CAA therapeutics and biomarkers for early diagnosis 4
- Considering the implications of amyloid-β immunotherapy for treating Alzheimer disease with comorbid CAA 5