Risk Factors, Imaging Features And Prognosis Of Cerebral Small Vessel Diseases

Background and Purpose: Few studies have reported on the risk factors of dilatedVirchow-Robin Spaces (dVRS) in large samples of ischemic stroke patients. Littleevidence exists regarding the relationship between dVRS and etiologic subtype ofischemic stroke or lacune. We aimed to investigate the risk factors associated with theseverity of dVRS in a large sample of ischemic stroke patients.Methods: We consecutively enrolled1090patients who experienced an ischemicstroke within the past seven days and underwent a3.0T MRI scan in the ChineseIntraCranial AtheroSclerosis Study (ICAS). Clinical data and cranial MRIinformation of patients included age, sex, vascular risk factors, dVRS, leukoaraiosis,lacune, and etiologic subtype of ischemic stroke. Analyses were performed regardingthe risk factors associated with the severity of dVRS by univariate analysis andmultivariable ordinal logistic regression analysis.Results: Through multivariable ordinal logistic regression analysis, age, admissionNational Institutes of Health Stroke Scale (NIHSS)?3, the severity of leukoaraiosis,lacune, and the severity of dVRS in the white matter (WM) and hippocampus (Hip)were correlated with the severity of dVRS in basal ganglia (BG); male, admissionNIHSS?3, history of hypertension, and the severity of dVRS in BG and Hip werecorrelated with the severity of dVRS in WM; female, admission NIHSS>3, theseverity of leukoaraiosis, small artery occlusion subtype of ischemic stroke, and theseverity of dVRS in BG and WM were correlated with the severity of dVRS in Hip.Conclusion: dVRS is an indicator of cerebral small vessel diseases such asleukoaraiosis and lacune. However, the risk factors of dVRS differ in various brain regions. Background and Purpose: Leukoaraiosis is an indicator of small vessel disease, butlittle is known about the relationship between the severity of leukoaraiosis andetiologic subtype of ischemic stroke. Our study aimed to investigate the factorsassociated with the severity of leukoaraiosis, and the relationship between the severityof leukoaraiosis and etiologic subtype of ischemic stroke.Methods:791patients with first-ever ischemic stroke within seven days wereenrolled in our study. We evaluated cranial magnetic resonance imagings includingseverity of leukoaraiosis in periventricular and deep white matter, severity of silentlacunar infarcts, etiologic subtype of ischemic stroke, and topographic patterns ofacute cerebral infarcts. Severity of leukoaraiosis was graded as grade0when Fazekasscores=0, grade1when Fazekas scores ranged from1to2, and grade2whenFazekas scores?3. Multivariable ordinal logistic regression was used to analyze thefactors associated with the severity of leukoaraiosis.Results:748patients (94.6%) had leukoaraiosis, the numbers and proportions ofgrade0, grade1and grade2leukoaraiosis were43(5.4%),413(52.2%) and335(42.4%), respectively. In multivariable ordinal logistic regression analysis, increasingage, higher diastolic blood pressure, admission National Institutes of Health StrokeScale?3, presence of silent lacunar infarcts, and small-artery occlusion subtype ofischemic stroke were found to be independently associated with higher grade ofleukoaraiosis.Conclusions: Leukoaraiosis is prevalent in first-ever ischemic stroke patients. Severeleukoaraiosis is more frequently associated with higher grades of silent lacunar infarcts and ischemic stroke due to small-artery occlusion. Background and Purpose: There is little information on the relationship betweensilent lacunar infarction (SLI) and etiologic subtype of ischemic stroke. So, we soughtto identify the risk factors of SLI, and analyze the relationship between the presenceof SLI and the etiologic subtype of ischemic stroke.Methods: Overall,791patients within7days of their first-ever non-cardiogenicischemic stroke were enrolled consecutively. Demographic information, vascular riskfactors were recorded. We evaluated cranial magnetic resonance imaging includingnumber of SLI, severity of leukoaraiosis, etiologic subtype of ischemic stroke, andtopographic patterns of acute cerebral infarcts. Factors associated with the presence ofSLI were analyzed.Results: A total of296patients (37.4%) had SLI. In univariate analysis, older age,hypertension, higher admission blood pressure, diabetes, history of cerebralhemorrhage, Fazekas scores?3, ischemic stroke due to small artery occlusion (SAO),single infarct, absence of small cortical infarct, absence of watershed infarcts andabsence of territorial infarct were significantly associated with the presence of SLI. Inmultivariable logistic regression analysis, male, hypertension, higher diastolic bloodpressure, diabetes, history of cerebral hemorrhage, Fazekas scores?3, and SAOsubtype stroke were significantly associated with the presence of SLI.Conclusions: First-ever non-cardiogenic ischemic stroke patients with SLI often havesevere leukoaraiosis and more often suffer from SAO subtype stroke than thosewithout SLI. Background: T2*-weighted gradient echo magnetic resonance imaging is sensitivein detecting cerebral microbleeds (MBs), but there are few reports on the risk factorsof MBs in different brain regions. Therefore, we aimed to investigate whether the riskfactors associated with the presence of MBs in strictly deep or lobar brain regionswere different.Methods: This study consisted of696consecutive acute ischemic stroke patientsfrom6hospitals in the Chinese IntraCranial AtheroSclerosis Study. We evaluated thenumber and location of MBs, severity of lacune and leukoaraiosis (LA), and etiologicsubtype of ischemic stroke. Multivariable logistic regression was used to analyze riskfactors of MBs in different brain regions.Results: Among696acute ischemic stroke patients,162patients (23.3%) had MBs.Of them,62patients had strictly deep brain MBs,49patients had strictly lobar MBs.There was a significant correlation between the number of MBs, the number of lacuneand the severity of LA (P<0.0001). In multivariable logistic regression analysis, bothstrictly deep and strictly lobar brain MBs were significantly associated with history ofcerebral hemorrhage (P=0.037and P=0.026, respectively), presence of lacune(P=0.004and P=0.032, respectively), and severe LA (P=0.002and P=0.008,respectively). However, MBs in strictly deep regions were significantly associatedwith higher mean arterial pressure (P=0.030), and those in strictly lobar brain regionswere significantly associated with older age (P=0.023).Conclusions: The risk factors of MBs in strictly deep or lobar regions differ modestly,which may be related to heterogeneous vascular pathological changes. Background and Purpose—Single subcortical infarction (SSI) may be classified asproximal SSI (pSSI) or distal SSI (dSSI) according to its location within the middlecerebral artery (MCA) territory. Very few studies have examined the differences inclinical outcome between the two. Our study investigated such differences in patientswith pSSI or dSSI, and examined their baseline characteristics and indicators forsmall vessel disease.Methods—We prospectively enrolled400patients with SSI (208pSSI and192dSSI)who had no MCA disease on MR angiography. Data compared included clinicalinformation, lesion size, prevalence of lacune and leukoaraiosis at baseline, NationalInstitutes of Health Stroke Scale (NIHSS) score and modified Rankin Scale (mRS)score at discharge, and any deterioration during admission or recurrence of ischemicstroke (IS) within1year.Results—In multivariable logistic regression analysis, dSSI was independentlyassociated with patient's history of stroke, admission NIHSS score?3, Fazekas scores?3, presence of lacune, but not hyperlipidemia. Patients with dSSI had shorter lengthof hospital stay, lower rate of functional dependence at discharge (mRS?2), andlower deterioration or recurrence risk of IS in1year. Multivariable logistic regressionanalysis showed that factors associated with higher deterioration or recurrence risk ofIS at one year included female gender, history of coronary heart disease, pSSI, andnot on antithrombotics within48hours of admission.Conclusion—Compared to pSSI, patients with dSSI likely had small vessel diseasesbut better clinical outcome. Background and Purpose: There is little information on the relationship betweencerebral small vessel disease and the outcome of ischemic stroke. So, we sought toidentify the risk factors associated with the outcome of ischemic stroke, and analyzethe relationship between cerebral small vessel disease and the outcome of ischemicstroke.Methods: Overall,791patients within7days of their first-ever non-cardiogenicischemic stroke were enrolled consecutively. Demographic information, vascular riskfactors were recorded. We evaluated cranial magnetic resonance imaging includingseverity of leukoaraiosis, number of SLI, location and severity of dVRS, etiologicsubtype of ischemic stroke, and topographic patterns of acute cerebral infarcts.Factors associated with the outcome of ischemic stroke were analyzed.Results: A total of14patients (1.8%) died,38patients (4.8%) developed recurrenceof ischemic stroke or TIA, and253patients (33%) were dependent in daily activitiesin one year after stroke onset. In multivariable logistic regression analysis, presenceof silent lacunar infarct, presence of milder dVRS, and presence of acute corticalcerebral infarction, without antithrombotics at admission were predictors of death inone year, while leukoaraiosis had no influence on death in one year. Coronary heartdisease, admission NIHSS <4, responsible artery stenosis?70%, and withoutantithrombotics at discharge were risk factors associated with recurrence of ischemicstroke or TIA in1year, while leukoaraiosis, silent lacunar infarct and dVRS had noimpacts on recurrence of ischemic stroke or TIA in1year. Hypertension, coronaryheart disease, admission NIHSS?4, presence of territorial infarct, presence of cerebral infarction in perforating artery territory or anterior cortical watershed infarcts,without antithrombotics at discharge, without statins at discharge, and withoutantithrombotics one year after stroke onset were significantly associated withdependence in daily activities one year after stroke onset. However, leukoaraiosis,silent lacunar infarct, and dVRS had no influence on dependence in daily activities atone year after stroke.Conclusions: Presence of silent lacunar infarct or milder dVRS werepredictors of death at one year after stroke. However, leukoaraiosis, silent lacunarinfarct, and dVRS had no influence on dependence in daily activities or recurrence ofischemic stroke or TIA in1year. There were differences in the influence of differenttypes of cerebral small vessel diseases on prognosis of ischemic stroke.