Association between Brachial-Ankle Arterial Stiffness and Cerebral Small Vessel Disease Load in Patients with Acute NonCardioembolic Ischemic Stroke

Background: Association between high homocysteine level and cerebral small-vessel disease has been implicated in cross-sectional studies, but results from longitudinal studies have been less clear. The aim of this study was to investigate whether homocysteine level at 3-months poststroke relates to the occurrence of white matter changes (WMC), the surrogate of cerebral small-vessel disease. We also investigated whether it relates to the prognosis after ischemic stroke regarding the risk of dementia at 3-months and mortality in long-term follow-up. Methods: A total of 321 consecutive acute ischemic stroke patients aged 55 to 85 were included in the study and followed up to 12 years. Plasma homocysteine level and occurrence of WMC in MRI were measured 3 months poststroke and dementia according to DSM-III was evaluated at the same time. Findings: The median homocysteine level was 13.50 μmol/l (interquartile range [IQR] 10.60-18.50 μmol/l). Total of 81 patients (25.2%) had homocysteine level above 18.50 μmol/l. In logistic regression analysis, homocysteine level above 18.50 μmol/l was not associated with severe WMC nor with dementia at 3 months poststroke. In Kaplan-Meier analysis, homocysteine level above 18.50 μmol/l was not associated with survival in 12-year follow-up. For further analysis, the group was divided in quartiles according to homocysteine level. The quartiles did not differ in occurrence of severe WMC at baseline, in the risk of dementia at 3 months, nor in the risk of mortality in 12-year follow-up. Interpretation: In our poststroke cohort homocysteine level is not associated with WMC. Further, it does not relate to impaired prognosis manifested as dementia at 3 months or mortality in 12-year follow-up.

Download Full-text

Abstract TP572: Electrocardiogram T Wave Abnormalities are Associated With the Total Burden of Cerebral Small Vessel Disease in Patients With Acute Ischemic Stroke or Transient Ischemic Attack

Stroke ◽

10.1161/str.50.suppl_1.tp572 ◽

2019 ◽

Vol 50 (Suppl_1) ◽

Author(s):

Monica Sarkar ◽

Christine Salloum ◽

Kimerly A Powell ◽

Michel T Torbey ◽

Yousef Hannawi

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Transient Ischemic Attack ◽

Small Vessel Disease ◽

Cerebral Small Vessel Disease ◽

Small Vessel ◽

Vessel Disease ◽

T Wave ◽

Total Burden ◽

Ischemic Attack

Download Full-text

Effects of cerebral small vessel disease on the outcome of patients with ischemic stroke caused by large artery atherosclerosis

Neurological Research ◽

10.1080/01616412.2018.1446283 ◽

2018 ◽

Vol 40 (5) ◽

pp. 381-390 ◽

Cited By ~ 4

Author(s):

Hui Zhu ◽

Zhixing Li ◽

Jinglei Lv ◽

Renliang Zhao

Keyword(s):

Ischemic Stroke ◽

Small Vessel Disease ◽

Cerebral Small Vessel Disease ◽

Small Vessel ◽

Large Artery ◽

Vessel Disease

Download Full-text

Prevalence and Effect of Cerebral Small Vessel Disease in Stroke Patients With Aspirin Treatment Failure–A Hospital-Based Stroke Secondary Prevention Registry

Frontiers in Neurology ◽

10.3389/fneur.2021.645444 ◽

2021 ◽

Vol 12 ◽

Author(s):

Ping-Song Chou ◽

Pi-Shan Sung ◽

Chi-Hung Liu ◽

Yueh-Feng Sung ◽

Ray-Chang Tzeng ◽

...

Keyword(s):

Logistic Regression ◽

Ischemic Stroke ◽

Treatment Failure ◽

Rating Scale ◽

Small Vessel Disease ◽

Demographic Data ◽

Cerebral Small Vessel Disease ◽

Small Vessel ◽

Stroke Patients ◽

Vessel Disease

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.

Download Full-text