Homocysteine, small-vessel disease, and atherosclerosis: An MRI study of 825 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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Altered Brain Function in Cerebral Small Vessel Disease Patients With Gait Disorders: A Resting-State Functional MRI Study

Frontiers in Aging Neuroscience ◽

10.3389/fnagi.2020.00234 ◽

2020 ◽

Vol 12 ◽

Author(s):

Xia Zhou ◽

Chao Zhang ◽

Linlin Li ◽

Yimei Zhang ◽

Wei Zhang ◽

...

Keyword(s):

Functional Mri ◽

Resting State ◽

Brain Function ◽

Small Vessel Disease ◽

Cerebral Small Vessel Disease ◽

Gait Disorders ◽

Small Vessel ◽

Vessel Disease ◽

Mri Study

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Cerebral small vessel disease MRI features do not improve the prediction of stroke outcome

Neurology ◽

10.1212/wnl.0000000000011208 ◽

2020 ◽

pp. 10.1212/WNL.0000000000011208

Author(s):

Coutureau Juliette ◽

Asselineau Julien ◽

Perez Paul ◽

Kuchcinski Gregory ◽

Sagnier Sharmila ◽

...

Keyword(s):

Predictive Accuracy ◽

Small Vessel Disease ◽

Added Value ◽

Psychological Status ◽

Small Vessel ◽

Perivascular Spaces ◽

Stroke Outcome ◽

Stroke Patients ◽

Vessel Disease ◽

Mri Features

Objective:To determine whether the total small vessel disease (SVD) score adds information to the prediction of stroke outcome compared to validated predictors, we tested different predictive models of outcome in stroke patients.Methods:White matter hyperintensity, lacunes, perivascular spaces, microbleeds, and atrophy were quantified in two prospective datasets of 428 and 197 first-ever stroke patients, using MRI collected 24-to-72 hours after stroke onset. Functional, cognitive, and psychological status were assessed at the 3–6 month follow-up. The predictive accuracy (in terms of calibration and discrimination) of age, baseline NIHSS, and infarct volume was quantified (model-1) on dataset-1, the total SVD score was added (model-2), and the improvement in predictive accuracy was evaluated. These two models were also developed in dataset-2 for replication. Finally, in model-3, the MRI features of cerebral SVD were included rather than the total SVD score.Results:Model-1 showed excellent performance for discriminating poor vs. good functional outcomes (AUC=0.915), and fair performance for identifying cognitively impaired and depressed patients (AUCs, 0.750 and 0.688 respectively). A higher SVD score was associated with a poorer outcome (odds ratio=1.30 [1.07, 1.58], p=0.0090 at best for functional outcome). However, adding the total SVD score (model-2) or individual MRI features (model-3) did not improve the prediction over model-1. Results for dataset-2 were similar.Conclusions:Cerebral SVD was independently associated with functional, cognitive, and psychological outcomes, but had no clinically relevant added value to predict the individual outcomes of patients when compared to the usual predictors, such as age and baseline NIHSS.

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Pre-micro RNA polymorphism detection in small versus large vessel disease in stroke patients

QJM ◽

10.1093/qjmed/hcaa054.015 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

H H Elkhawas ◽

H H Afify ◽

H Shokri ◽

E Hassan ◽

A Alzahaby

Keyword(s):

Small Vessel Disease ◽

Susceptibility Gene ◽

Large Vessel ◽

Small Vessel ◽

Stroke Patients ◽

Functional Polymorphisms ◽

Vessel Disease ◽

Stroke Subtypes ◽

Micro Rnas ◽

Large Vessel Disease

Abstract Article Outline Abstract Introduction Patients and methods Procedure Statistical analysis Results Discussion Conclusion References Background Cerebrovascular accidents are the second leading cause of death and the third leading cause of disability worldwide. The methods currently available for diagnosis and prognosis of cerebral ischaemia still require further improvements. Micro-RNAs (small non-coding RNAs) have been recently reported as useful biomarkers in diseases such as cancer and diabetes. Further research concerned with microRNA (miRNA) profiling from peripheral blood to detect and identify characteristic patterns in ischaemic stroke is crucial. Aim of the work This study aims to investigate the association between three potentially functional polymorphisms in pre-miRNAs and stroke subtypes (small vessel disease and large vessel disease) in a sample of Egyptian stroke patients. Patients and Methods This is a cross sectional study conducted in Ain Shams University Hospitals in which 81 patients presenting with cerebrovascular stroke fulfilling criteria of small vessel disease (SVD) or large vessel disease (LVD) according to TOAST [2] classification in the period from March 2018 to August 2018 were included. Blood samples were withdrawn for DNA extraction to investigate the association between three potentially functional polymorphisms (rs2910164, rs11614913, and rs3746444) in pre-miRNAs (hsamiR-146a, hsa-miR-196a2, and hsa-miR-499, respectively). Results Smoking, hypertension and diabetes were significant value in both stroke subtypes. Meanwhile, age and gender showed no significance between both stroke subtypes. Conclusion Ischemic stroke has polygenic basis, but identification of stroke susceptibility gene and quantification of associated risks has been hindered by conflicting results from different studies.

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Abstract P549: Total Small Vessel Disease Burden Not Associated With Functional Independence After Endovascular Treatment in Acute Ischemic Stroke Patients

Stroke ◽

10.1161/str.52.suppl_1.p549 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Lina Zheng ◽

Xinyi Leng ◽

Ximing Nie ◽

Hongyi Yan ◽

Thomas W Leung ◽

...

Keyword(s):

Endovascular Treatment ◽

Primary Outcome ◽

Small Vessel Disease ◽

Functional Independence ◽

Small Vessel ◽

Perivascular Spaces ◽

Stroke Patients ◽

Vessel Occlusion ◽

Vessel Disease ◽

Secondary Outcomes

Background: Individual small vessel disease (SVD) markers had been associated with outcomes of endovascular treatment (EVT) in acute stroke patients. We aimed to investigate the associations between total SVD burden and outcomes in such patients. Methods: In a nation-wide multicenter registration study, we enrolled stroke patients with anterior circulation large vessel occlusion (LVO) receiving EVT, who had undergone 3T MRI. Presence of lacunes, white matter hyperintensities, cerebral microbleeds and perivascular spaces in both hemispheres were assessed in MRI and each marker was assigned a score of 0 or 1 by presence. A total SVD burden score (0-4) was calculated by summing up the individual scores, which was dichotomized as none-to-mild (score 0-2) and moderate-to-severe (score 3-4). The primary outcome was 90-day functional independence, defined as modified Rankin Scale (mRS) of 0-2. Secondary outcomes included change in NIHSS from baseline to 7 days, early neurological deterioration (END), symptomatic intracranial hemorrhage and 90-day mortality. We investigated the associations of dichotomized total SVD burden score with the outcomes using binary logistic regression analyses. Results: Of the 202 patients (65.38% male; mean age 65.54 ± 11.93 years) enrolled, 176 patients had none-to-mild and 26 had moderate-to-severe total SVD burden. Those with moderate-to-severe SVD were older (mean age 69.8 versus 64.7; P=0.043) and more of them had a prior stroke (42.31% versus 23.3%; P=0.039), compared with otherwise. Dichotomized total SVD burden was not significantly associated with the primary outcome, 90-day functional independence (moderate-to-severe versus none-to-mild SVD burden: 53.85% versus 47.13%; OR 0.76, 95% CI 0.33-1.75; P=0.523). Although moderate-to-severe total SVD burden was associated with a higher rate of END (15.38% versus 3.43%; OR 5.12; 95% CI 1.34-19.58; P=0.017), no significant association was detected between the total SVD burden and other secondary outcomes. Conclusions: The total SVD burden as assessed in MRI was not significantly associated with the chance of obtaining functional independence at 90 days in LVO-stroke patients receiving EVT. A higher total SVD burden may not be an exclusion criteria for clinical decision for EVT.

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Coexisting Small Vessel Disease Predicts Poor Long-Term Outcome in Stroke Patients with Intracranial Large Artery Atherosclerosis

Cerebrovascular Diseases ◽

10.1159/000319574 ◽

2010 ◽

Vol 30 (5) ◽

pp. 433-439 ◽

Cited By ~ 13

Author(s):

Jian Hui Fu ◽

Yang Kun Chen ◽

Xiang Yan Chen ◽

Vincent Mok ◽

Ka Sing Wong

Keyword(s):

Small Vessel Disease ◽

Small Vessel ◽

Large Artery ◽

Stroke Patients ◽

Term Outcome ◽

Long Term Outcome ◽

Vessel Disease

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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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Abstract W P345: Increased Risk of Gastrointestinal Bleeding Associated With Antiplatelet Therapy in Patients With Cerebral Small Vessel Disease

Stroke ◽

10.1161/str.45.suppl_1.wp345 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Sang-mi Noh ◽

Jong S. Kim

Keyword(s):

White Matter ◽

White Matter Hyperintensities ◽

Small Vessel Disease ◽

Bleeding Risk ◽

Cerebral Small Vessel Disease ◽

Small Vessel ◽

Gi Bleeding ◽

Stroke Patients ◽

Vessel Disease ◽

Increased Risk

Background: Gastrointestinal (GI) bleeding is a major complication of aniplatelets in patients with stroke. Although underlying gastrointestinal disease is an important factor for increased bleeding risk, the presence of cerebral small vessel disease (SVD) may also be a factor because it may indicate systemic small vessel pathologies. We assessed the association of cerebral SVD and GI bleeding in patients who are under treatment with antiplatelets for secondary stroke prevention. Methods: We compared stroke patients who visited our clinic between May 2007 and May 2013 who developed GI bleeding while receiving antiplatelets with age and sex matched patients who did not. Control subjects were randomly selected among those who were visited out-patients clinic on the same day as the study subjects. Patients who received anticoagulants were excluded. MRIs were evaluated for the presence of white matter changes (Fazeka scale) and microbleeds. Results: During the study period, 47 patients in the bleeding group and 94 patients in the control group were enrolled. No differences were found in baseline characteristics between the two groups including stroke subtypes and the number of antiplatelets (mono vs dual therapy). The prevalence of SVD (microbleeds or white matter hyperintensities) (p = 0.004), white matter hyperintensities (p = 0.008), but not microbleeds alone (p = 0.221), were significantly higher in the bleeding group. Multivariate analysis showed that the presence of SVD was independently associated with increased GI bleeding risk (OR 3.3, 95% confidence interval 1.5-7.3). Conclusions: Our data show the presence of cerebral SVD is a marker for increased GI bleeding risk in patients receiving antiplatelets in stroke patients, perhaps related with systemic small vessel pathology in this group of patients. Physicians may have to consider this association when antiplatelets are used for the secondary prevention of stroke.

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