Abstract T MP35: Frequency, Risk Factors, and Impact of Coexistent Small Vessel Disease in the SAMMPRIS Trial

Background: Intracranial atherosclerotic stenosis (ICAS) and small vessel disease (SVD) may coexist. We investigated the frequency and risk factors for SVD in SAMMPRIS patients and the impact of SVD on stroke recurrence in the medical arm of the trial. Methods: Of 451 patients enrolled in SAMMPRIS, 313 had baseline brain MRIs read centrally for SVD. SVD was defined by any of the following: old lacunar infarction, Fazekas score of 2-3 for white matter hyperintensities, or microbleeds. We compared risk factors in patients with vs. without SVD using Fisher’s exact test (for percentages), independent groups t test (for means) or Wilcoxon rank sum test (for medians), and compared the survival curves of patients with vs. without SVD in the medical arm for ischemic stroke in the territory of the stenotic artery and any ischemic stroke using the logrank test. Results: Of the 313 patients, 161 (51.4%) had SVD on the baseline MRI. Variables that were significantly (p<0.05) higher in patients with SVD were age, diabetes, lipid disorder, baseline SBP, coronary disease, and old infarct in the territory. The Kaplan-Meier curves in the figure show that patients with SVD were at significantly higher risk of any ischemic stroke (p = 0.048) but not stroke in the territory (p = 0.10) compared with patients without SVD. Conclusion: SVD in patients with ICAS is common, especially in patients who are older, diabetic, hyperlipidemic, and have higher SBP. Patients with ICAS and coexistent SVD are at higher risk of any ischemic stroke but may not be at higher risk for stroke in the territory.

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Total Cerebral Small Vessel Disease Burden on MRI Correlates With Medial Temporal Lobe Atrophy and Cognitive Performance in Patients of a Memory Clinic

Frontiers in Aging Neuroscience ◽

10.3389/fnagi.2021.698035 ◽

2021 ◽

Vol 13 ◽

Author(s):

Yangyi Fan ◽

Ming Shen ◽

Yang Huo ◽

Xuguang Gao ◽

Chun Li ◽

...

Keyword(s):

Risk Factors ◽

Small Vessel Disease ◽

Brain Mri ◽

Cognitive Status ◽

Cerebral Small Vessel Disease ◽

Small Vessel ◽

Memory Clinic ◽

Vessel Disease ◽

Mri Features ◽

The Impact

Background: Cerebral small vessel disease (cSVD) and neurodegeneration are the two main causes of dementia and are considered distinct pathological processes, while studies have shown overlaps and interactions between the two pathological pathways. Medial temporal atrophy (MTA) is considered a classic marker of neurodegeneration. We aimed to investigate the relationship of total cSVD burden and MTA on MRI using a total cSVD score and to explore the impact of the two MRI features on cognition.Methods: Patients in a memory clinic were enrolled, who underwent brain MRI scan and cognitive evaluation within 7 days after the first visit. MTA and total cSVD score were rated using validated visual scales. Cognitive function was assessed by using Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scales. Spearman's correlation and regression models were used to test (i) the association between MTA and total cSVD score as well as each cSVD marker and (ii) the correlation of the MRI features and cognitive status.Results: A total of 312 patients were finally enrolled, with a median age of 75.0 (66.0–80.0) years and 40.7% (127/312) males. All of them finished MRI and MMSE, and 293 subjects finished MoCA. Of note, 71.8% (224/312) of the patients had at least one of the cSVD markers, and 48.7% (152/312) of them had moderate–severe MTA. The total cSVD score was independently associated with MTA levels, after adjusting for age, gender, years of education, and other vascular risk factors (OR 1.191, 95% CI 1.071–1.324, P = 0.001). In regard to individual markers, a significant association existed only between white matter hyperintensities and MTA after adjusting for the factors mentioned above (OR 1.338, 95% CI 1.050–1.704, P = 0.018). Both MTA and total cSVD score were independent risk factors for MMSE ≤ 26 (MTA: OR 1.877, 95% CI 1.407–2.503, P < 0.001; total cSVD score: OR 1.474, 95% CI 1.132–1.921, P = 0.004), and MoCA < 26 (MTA: OR 1.629, 95% CI 1.112–2.388, P = 0.012; total cSVD score: OR 1.520, 95% CI 1.068–2.162, P = 0.020). Among all the cSVD markers, microbleed was found significantly associated with MMSE ≤ 26, while no marker was demonstrated a relationship with MoCA < 26.Conclusion: Cerebral small vessel disease was related to MTA in patients of a memory clinic, and both the MRI features had a significant association with cognitive impairment.

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EXPRESS: Characteristics and Prognosis of Patients with Embolic Stroke of Undetermined Source in China

International Journal of Stroke ◽

10.1177/17474930211028040 ◽

2021 ◽

pp. 174749302110280

Author(s):

Xiaomeng Yang ◽

Jing Jing ◽

Xia Meng ◽

Zixiao Li ◽

Yuesong Pan ◽

...

Keyword(s):

Ischemic Stroke ◽

Small Vessel Disease ◽

Small Vessel ◽

Stroke Recurrence ◽

Cumulative Probability ◽

Large Artery ◽

Stroke Registry ◽

Vessel Disease ◽

Ischemic Attack ◽

Diagnostic Work

Background and purpose: We aimed to explore the frequencies, risk factors, and natural history of ESUS through a national prospective registry in China. Methods: Between August 2015 and March 2018, the Third China National Stroke Registry (CNSR-III) recruited consecutive patients with ischemic stroke or transient ischemic attack (TIA) in China. The baseline characteristics, risks of stroke, and mortality in patients with ESUS were described and compared with that in patients with other causative subtypes. Results: A total of 15166 TIA and ischemic stroke patients were enrolled in CNSR-III. Among 8528 ischemic stroke with standard diagnostic work-up, 2415 (28.3%) patients were diagnosed with ESUS. The mean age was 61 years and 70% of them were male. Compared to patients with cardioembolic strokes and small vessel disease, patients with ESUS had higher prevalence of nonstenosing large artery atherosclerosis (37.93% vs 31.26%, P=0.008 and 37.93% vs 34.40%, P=0.044 respectively). The cumulative probability of stroke recurrence in patients with ESUS at 3 month and 1 year was 5.59% and 8.74%. Compared with ESUS patients (0.70% and 1.99%), patients with the large artery atherosclerosis and cardioembolic strokes had higher cumulative probability of death at 3 month (1.94% and 3.22%) and 1 year (4.17% and 7.39%). Conclusions: ESUS is a common cause of ischemic stroke in Chinese population with a higher stroke recurrence of ESUS than previous reported. It was more likely to have nonstenosing large artery atherosclerosis in patients with ESUS than with cardioembolic strokes and small vessel disease.

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Cerebral small vessel disease in Indonesia: Lacunar infarction study from Indonesian Stroke Registry 2012–2014

SAGE Open Medicine ◽

10.1177/2050312118784312 ◽

2018 ◽

Vol 6 ◽

pp. 205031211878431 ◽

Cited By ~ 1

Author(s):

Salim Harris ◽

Mohammad Kurniawan ◽

Al Rasyid ◽

Taufik Mesiano ◽

Rakhmad Hidayat

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Subarachnoid Hemorrhage ◽

Small Vessel Disease ◽

Cerebral Small Vessel Disease ◽

Lacunar Infarction ◽

Small Vessel ◽

Factors Associated ◽

Vessel Disease ◽

Large Groups

Background and Purpose: Stroke is the number one cause of morbidity and mortality in Indonesia. Lacunar infarction is one of cerebral small vessel disease spectrum. This study aimed to present stroke epidemiology in Indonesia and risk factors associated with cerebral small vessel disease. Methods: A multicenter prospective cross-sectional study of 18 hospitals in Indonesia was conducted using Stroke Case Report Form from 2012 to 2014. Stroke was diagnosed based on clinical findings confirmed with non-contrast computed tomography of the brain. Subjects were classified into two large groups: ischemic (lacunar and non-lacunar) and hemorrhagic (intracranial and subarachnoid hemorrhage). Other risk factors were assessed on admission. Results: We enrolled 5411 patients, of whom 3627 (67.03%) had ischemic stroke and 1784 (32.97%) had hemorrhagic stroke. Male patients were prevalent in both large groups, although found less in subarachnoid hemorrhage group. Among patients with hemorrhagic stroke, 1603 (89.54%) of them had intracerebral hemorrhage and 181 (10.46%) had subarachnoid hemorrhage. From 3627 ischemic stroke patients, 1635 (45.07%) of them had lacunar infarction. We found that age above 55 years old, male gender, hypertension, dyslipidemia, and diabetes were important risk factors associated with lacunar stroke (p < 0.05). Conclusion: Ischemic stroke was the leading cause of stroke in Indonesia. In total, 45% of the total ischemic stroke patients had lacunar infarction. Important risk factors associated with lacunar infarction were hypertension, dyslipidemia, diabetes, age over 55, and male population.

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Severity of Small Vessel Disease Biomarkers Reduces the Magnitude of Cognitive Recovery after Ischemic Stroke

Cerebrovascular Diseases ◽

10.1159/000513916 ◽

2021 ◽

pp. 1-8

Author(s):

Sharmila Sagnier ◽

Gwenaëlle Catheline ◽

Fanny Munsch ◽

Antoine Bigourdan ◽

Mathilde Poli ◽

...

Keyword(s):

Ischemic Stroke ◽

Cognitive Assessment ◽

Small Vessel Disease ◽

Brain Mri ◽

Small Vessel ◽

Perivascular Spaces ◽

Cognitive Recovery ◽

Vessel Disease ◽

The Impact ◽

Over Time

Objective: The objective of this study was to evaluate the impact of radiological biomarkers suggestive of cerebral small vessel disease (SVD) on the evolution of cognitive performances after an ischemic stroke (IS). Methods: We studied patients with a supratentorial IS recruited consecutively to a prospective monocentric longitudinal study. A cognitive assessment was performed at baseline, 3 months, and 1 year and was based on a Montreal Cognitive Assessment, an Isaacs set test of verbal fluency (IST), and a Zazzo’s cancellation task (ZCT) for the evaluation of attentional functions and processing speed. The following cerebral SVD biomarkers were detected on a 3-T brain MRI performed at baseline: white matter hyperintensities (WMHs), deep and lobar microbleeds, enlarged perivascular spaces in basal ganglia and centrum semiovale, previous small deep infarcts, and cortical superficial siderosis (cSS). Generalized linear mixed models were used to evaluate the relationship between these biomarkers and changes in cognitive performances. Results: A total of 199 patients (65 ± 13 years, 68% male) were analyzed. Overall, the cognitive performances improved, more significantly in the first 3 months. Severe WMH was identified in 34% of the patients, and focal cSS in 3.5%. Patients with severe WMH and focal cSS had overall worse cognitive performances. Those with severe WMH had less improvement over time for IST (β = −0.16, p = 0.02) and the number of errors to ZCT (β = 0.19, p = 0.02), while those with focal cSS had less improvement over time for ZCT completion time (β = 0.14, p = 0.01) and number of errors (β = 0.17, p = 0.008), regardless of IS volume and location, gray matter volume, demographic confounders, and clinical and cardiovascular risk factors. Conclusion: The severity of SVD biomarkers, encompassing WMH and cSS, seems to reduce the magnitude of cognitive recovery after an IS. The detection of such SVD biomarkers early after stroke might help to identify patients with a cognitive vulnerability and a higher risk of poststroke cognitive impairment.

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Cerebral Small Vessel Disease

International Journal of Molecular Sciences ◽

10.3390/ijms21249729 ◽

2020 ◽

Vol 21 (24) ◽

pp. 9729

Author(s):

Jakub Litak ◽

Marek Mazurek ◽

Bartłomiej Kulesza ◽

Paweł Szmygin ◽

Joanna Litak ◽

...

Keyword(s):

Small Vessel Disease ◽

Current Knowledge ◽

Cerebral Small Vessel Disease ◽

Cerebral Vessels ◽

Small Vessel ◽

Epithelial Layer ◽

Small Arteries ◽

Vessel Disease ◽

The Impact ◽

Cerebral Small Vessel Diseases

Cerebral small vessel disease (CSVD) represents a cluster of various vascular disorders with different pathological backgrounds. The advanced vasculature net of cerebral vessels, including small arteries, capillaries, arterioles and venules, is usually affected. Processes of oxidation underlie the pathology of CSVD, promoting the degenerative status of the epithelial layer. There are several classifications of cerebral small vessel diseases; some of them include diseases such as Binswanger’s disease, leukoaraiosis, cerebral microbleeds (CMBs) and lacunar strokes. This paper presents the characteristics of CSVD and the impact of the current knowledge of this topic on the diagnosis and treatment of patients.

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Abstract WP266: Microembolic Signals and Association With Stroke Etiology in Ischemic Stroke

Stroke ◽

10.1161/str.51.suppl_1.wp266 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Michael M Chen ◽

Simin Mahinrad ◽

Arth K Srivastava ◽

Eric Liotta ◽

Richard A Bernstein ◽

...

Keyword(s):

Small Vessel Disease ◽

Transcranial Doppler Ultrasound ◽

Small Vessel ◽

Stroke Recurrence ◽

Additional Information ◽

Vessel Disease ◽

Stroke Etiology ◽

Chi Squared ◽

Prognostic Utility ◽

History Of

Background: Microembolic signals (MES) detected by the transcranial Doppler ultrasound (TCD) have established prognostic value for stroke recurrence in patients with carotid stenosis. However, the frequency of MES in the context of other stroke etiologies remains unknown. Methods: All stroke admissions to Northwestern Memorial hospital between 2016-2018 who underwent TCD within the first 48 hours of admission were reviewed. Final stroke diagnosis was extracted from chart review. Presence or absence of MES was extracted from clinical TCD reports. Frequency of stroke etiology among MES groups were compared using chi-squared test. Results: A total of 789 patient charts were reviewed (mean age 62±17 years, 55% male). MES were present in 95 patients. Demographics and medical history of patients were not different among those with and without MES. Compared to patients without MES, those with MES were more frequently diagnosed with cardioembolic stroke (36.4% vs 21%, p =0.001) and less frequently with small vessel disease stroke (5.7% vs 24%, p <0.001). However, there was no difference in the frequency of cryptogenic strokes between patients with and without MES ( p =0.844). Among patients with MES, the most frequent etiologies of stroke were cardioembolic (36.4%), cryptogenic (19.3%), large vessel disease (17.1%), and small vessel disease (5.7%). Conclusion: TCD detection of MES is seen across all stroke subtypes and may provide additional information for risk stratification in secondary stroke prevention. We are currently reviewing the prognostic utility of MES for stroke recurrence in this cohort.

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1 Acute Ischemic Stroke: Small Vessel Disease

Decision Making in Neurovascular Disease ◽

10.1055/b-0038-162130 ◽

2018 ◽

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Small Vessel Disease ◽

Small Vessel ◽

Vessel Disease

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A Proposed Hypothesis on Dementia: Inflammation, Small Vessel Disease, and Hypoperfusion Is the Sequence That Links All Harmful Lifestyles to Cognitive Impairment

Frontiers in Aging Neuroscience ◽

10.3389/fnagi.2021.679837 ◽

2021 ◽

Vol 13 ◽

Author(s):

Antoine M. Hakim

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Cognitive Impairment ◽

Cerebral Perfusion ◽

Small Vessel Disease ◽

Negative Impact ◽

Small Vessel ◽

Vessel Disease ◽

Sequence Of Events ◽

Do So

There is growing consensus that certain lifestyles can contribute to cognitive impairment and dementia, but the physiological steps that link a harmful lifestyle to its negative impact are not always evident. It is also unclear whether all lifestyles that contribute to dementia do so through the same intermediary steps. This article will focus on three lifestyles known to be risk factors for dementia, namely obesity, sedentary behavior, and insufficient sleep, and offer a unifying hypothesis proposing that lifestyles that negatively impact cognition do so through the same sequence of events: inflammation, small vessel disease, decline in cerebral perfusion, and brain atrophy. The hypothesis will then be tested in a recently identified risk factor for dementia, namely hearing deficit. If further studies confirm this sequence of events leading to dementia, a significant change in our approach to this debilitating and costly condition may be necessary, possible, and beneficial.

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