Frontal lobe atrophy is associated with small vessel disease in ischemic stroke patients

Background: Breakthrough strokes during treatment with aspirin, termed clinical aspirin treatment failure (ATF), is common in clinical practice. The burden of cerebral small vessel disease (SVD) is associated with an increased recurrent ischemic stroke risk. However, the association between SVD and ATF remains unclear. This study investigated the prevalence and clinical characteristics of SVD in stroke patients with ATF.Methods: Data from a prospective, and multicenter stroke with ATF registry established in 2018 in Taiwan were used, and 300 patients who developed ischemic stroke concurrent with regular use of aspirin were enrolled. White matter lesions (WMLs) and cerebral microbleeds (CMBs) were identified using the Fazekas scale and Microbleed Anatomical Rating Scale, respectively. Demographic data, cardiovascular comorbidities, and index stroke characteristics of patients with different WML and CMB severities were compared. Logistic regression analyses were performed to explore the factors independently associated with outcomes after ATF.Results: The mean patient age was 69.5 ± 11.8 years, and 70.0% of patients were men. Among all patients, periventricular WML (PVWML), deep WML (DWML), and CMB prevalence was 93.3, 90.0, and 52.5%, respectively. Furthermore, 46.0% of the index strokes were small vessel occlusions. Severe PVWMLs and DWMLs were significantly associated with high CMB burdens. Patients with moderate-to-severe PVWMLs and DWMLs were significantly older and had higher cardiovascular comorbidity prevalence than did patients with no or mild WMLs. Moreover, patients with favorable outcomes exhibited significantly low prevalence of severe PVWMLs (p = 0.001) and DWMLs (p = 0.001). After logistic regression was applied, severe WMLs predicted less favorable outcomes independently, compared with those with no to moderate PVWMLs and DWMLs [odds ratio (OR), 0.47; 95% confidence interval (CI), 0.25–0.87 for severe PVWMLs; OR, 0.40; 95% CI, 0.21–0.79 for severe DWMLs].Conclusions: SVD is common in stroke patients with ATF. PVWMLs and DWMLs are independently associated with functional outcomes in stroke patients with ATF. The burden of SVD should be considered in future antiplatelet strategies for stroke patients after ATF.

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Effect of probucol on the progression of white matter hyperintensities in ischemic stroke patients with a higher burden of small vessel disease: the picasso mri-substudy

Journal of the Neurological Sciences ◽

10.1016/j.jns.2017.08.479 ◽

2017 ◽

Vol 381 ◽

pp. 164 ◽

Cited By ~ 1

Author(s):

S.H. Heo ◽

A.H. Cho ◽

J.H. Park ◽

J.S. Lee ◽

H.S. Kwon ◽

...

Keyword(s):

Ischemic Stroke ◽

White Matter ◽

White Matter Hyperintensities ◽

Small Vessel Disease ◽

Small Vessel ◽

Stroke Patients ◽

Vessel Disease

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25-Hydroxy vitamin D level is associated with total MRI burden of cerebral small vessel disease in ischemic stroke patients

International Journal of Neuroscience ◽

10.1080/00207454.2018.1503182 ◽

2018 ◽

Vol 129 (1) ◽

pp. 49-54 ◽

Cited By ~ 7

Author(s):

Chong Feng ◽

Nailong Tang ◽

He Huang ◽

Guiyun Zhang ◽

Xiangqian Qi ◽

...

Keyword(s):

Vitamin D ◽

Ischemic Stroke ◽

Small Vessel Disease ◽

Cerebral Small Vessel Disease ◽

Small Vessel ◽

Stroke Patients ◽

Vessel Disease ◽

25 Hydroxy Vitamin D

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Extracranial Artery Stenosis Is Associated With Total MRI Burden of Cerebral Small Vessel Disease in Ischemic Stroke Patients of Suspected Small or Large Artery Origins

Frontiers in Neurology ◽

10.3389/fneur.2019.00243 ◽

2019 ◽

Vol 10 ◽

Cited By ~ 2

Author(s):

Tao Lu ◽

Jiahui Liang ◽

Ninglin Wei ◽

Liya Pan ◽

Hong Yang ◽

...

Keyword(s):

Ischemic Stroke ◽

Small Vessel Disease ◽

Cerebral Small Vessel Disease ◽

Artery Stenosis ◽

Small Vessel ◽

Large Artery ◽

Stroke Patients ◽

Vessel Disease

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Abstract TP221: Deterioration of Glomerular Filtration Rate is Associated With Greater Cerebral Small Vessel Disease Burden in Ischemic Stroke Patients Aged Below 80 Years

Stroke ◽

10.1161/str.50.suppl_1.tp221 ◽

2019 ◽

Vol 50 (Suppl_1) ◽

Author(s):

Natalia R Balian ◽

Claudia Alonzo ◽

Laura Brescacin ◽

Clarisa Cea ◽

Pedro E Colla Machado ◽

...

Keyword(s):

Ischemic Stroke ◽

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Disease Burden ◽

Filtration Rate ◽

Small Vessel Disease ◽

Cerebral Small Vessel Disease ◽

Small Vessel ◽

Stroke Patients ◽

Vessel Disease

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Association of the atherosclerosis, small vessel disease, cardioembolism, other causes with the executive function of the montreal cognitive assessment Indonesia in patients with post ischemic stroke

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20191663 ◽

2019 ◽

Vol 7 (5) ◽

pp. 1707

Author(s):

Dwi Retno Hastani ◽

Aldy S. Rambe ◽

Kiki M. Iqbal

Keyword(s):

Ischemic Stroke ◽

Executive Function ◽

Cognitive Assessment ◽

Small Vessel Disease ◽

Montreal Cognitive Assessment ◽

Small Vessel ◽

Stroke Patients ◽

Memory Decline ◽

Vessel Disease ◽

Phenotype Classification

Background: ASCO Phenotype classification is a new classification of stroke based on phenotypic system. ASCO classification can evaluate the etiology of ischemic stroke comprehensively to characterize patients using different grade of evidence for the subtype of ischemic stroke. ASCO classification can predict post ischemic stroke cognitive decline. This Study purpose to evaluate the association between ASCO classification with the executive function in post ischemic stroke patients.Methods: This cross sectional study followed by 28 post ischemic stroke patients (men 16, women 12) over 3 months. Mean age 52.82±8.66. Cognitive function was assessed by Montreal Cognitive Assessment Indonesia (MoCA INA).Results: There were 17 patients with grade 1 atherosclerosis (ASCO A1), ten patients with grade 1 small vessel disease (ASCO S1), one patient with grade 1 cardioembolism (ASCO C1) in post ischemic stroke. Grade 1 atherosclerosis (ASCO A1) was significantly associated with executive function decline (p=0.002), naming decline (p=0.05), abstraction decline (p=0.001), memory decline (p=0.002) and orientation decline (p=0.016)). Grade 1 small vessel disease (ASCO S1) was significantly associated with executive function decline (p=0.001) and memory decline (p = 0.001) and abstraction (p=0.001). Grade 1 cardioembolism 1 (ASCO C1) was not significantly associated with cognitive decline.Conclusions: There was significant association between ASCO classification with the executive function of Montreal Cognitive Assestment Indonesia (MoCA INA) in post ischemic stroke patients.

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Abstract WP446: Increased Nighttime Blood Pressure and Small Vessel Diseases Are Strongly Associated With Cognitive Impairment Increased Nighttime Blood Pressure and Small Vessel Diseases Are Strongly Associated With Cognitive Impairment Ischemic Stroke Patients

Stroke ◽

10.1161/str.48.suppl_1.wp446 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Yasumasa Yamamoto ◽

Yoshinari Nagakane ◽

Yasuhiro Toimii ◽

Eijiro Tanaka ◽

Shintaro Toda

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Cognitive Impairment ◽

Small Vessel Disease ◽

Blood Pressure Monitoring ◽

Small Vessel ◽

Stroke Patients ◽

Vessel Disease ◽

Nighttime Blood Pressure ◽

Group A

Purpose: To explore the relationship between diurnal blood pressure (BP) pattern and small vessel diseases, and cognitive impairment in stroke patients. Methods: Twenty-four hour blood pressure monitoring for every 30 minutes was performed for 415 patients with ischemic stroke in chronic stage. Patients with modified Rankin Scale >2 were excluded. Patients whose Mini Mental State Examination <24 points were diagnosed as having cognitive impairment (CI). Silent lacunae and white matter lesions (WML) on MRI were identified and multiple lacunae and/or confluent WML were estimated as extensive small vessel disease (eSVD). When the nocturnal BP decline, calculated as (daytime BP -nighttime BP) / daytime BP, was more than 1.0, patients were classified as dipper, when 0-1.0 as non-dipper and when less than 0 as riser. Patients were classified into 7 groups. A: single lacuna without CI (n=110), B: multiple lacunae without CI (n=103), C: lacunar infarct with CI (n=70), D: atherothrombotic infarction (ATB) (n=71), E: ATB with CI (n=13), F: cardio embolic infarction (CE) (n=41), G: CE with CI (n=7). Results: Average 24-hour BP values (mmHg) and nocturnal BP decline were calculated. Nocturnal BP decline in the Groups with C, E and G showed significantly lower than group A. The prevalence of riser (%) in the Groups with C, E and G showed significantly higher than group A. The prevalence of eSVD in the Groups with E showed significantly higher than group D (p=0.0011) and groups G showed significantly higher than group F (p= 0.0026). Logistic regression analysis in all patients showed that more than 75 years old (versus less than 65 years old) (OR: 4.0, p=0.0006), eSVD (OR: 23.5, p<0.0001), and non-dipper and riser (versus dipper) (OR: 5.5, p=0.0003 and OR: 16.5, p<0.0001, respectively) were independently associated with CI after adjustment 24-hour averaged systolic blood pressure. Conclusions: Extensive small vessel disease and increased night time blood pressure, especially riser, were strong predictors for cognitive impairment in ischemic stroke patient. In patients with ATB and CE, eSVD was the determinant for cognitive impairment. Nighttime blood pressure, not just daytime blood pressure, should be focused on to prevent post-stroke cognitive impairment.

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