Small vessel disease burden and prognosis of recent subcortical ischaemic stroke differ by parent artery atherosclerosis

IF 4.5 2区医学 Q1 CLINICAL NEUROLOGY European Journal of Neurology Pub Date : 2024-08-03 DOI:10.1111/ene.16422

Qian-Qian Lin, Hui-Sheng Chen, Yi Yang, Meng Zhang, Shi-Wen Wu, Ming-Li Li, Yi-Ning Huang, Wei-Hai Xu, Stroke Imaging Package Study (SIPS) study Group

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Abstract

Background and purpose

Parent artery atherosclerosis is an important aetiology of recent subcortical ischaemic stroke (RSIS). However, comparisons of RSIS with different degrees of parent artery atherosclerosis are lacking.

Methods

Prospectively collected data from our multicentre cohort (all were tertiary centres) of the Stroke Imaging Package Study between 2015 and 2017 were retrospectively reviewed. The patients with RSIS defined as a single clinically relevant diffusion-weighted imaging positive lesion in the territory of lenticulostriate arteries were categorized into three subgroups: (1) normal middle cerebral artery (MCA) on magnetic resonance angiography and high-resolution magnetic resonance imaging (HR-MRI); (2) low-grade MCA atherosclerosis (normal or <50% stenosis on magnetic resonance angiography and with MCA plaques on HR-MRI); (3) steno-occlusive MCA atherosclerosis (stenosis ≥50% or occlusion). The primary outcome was 90-day functional dependence (modified Rankin Scale score >2). The clinical and imaging findings were compared between subgroups.

Results

A total of 239 patients (median age 60.0 [52.0–67.0] years, 72% male) were enrolled, including 140 with normal MCA, 64 with low-grade MCA atherosclerosis and 35 with steno-occlusive MCA atherosclerosis. Patients with steno-occlusive MCA atherosclerosis had the largest infarct volume. Low-grade MCA atherosclerosis was independently associated with cerebral microbleeding, more severe perivascular spaces in basal ganglia and higher total cerebral small vessel disease burden. Low-grade MCA atherosclerosis was an independent determinant of 90-day functional dependence (odds ratio 3.897; 95% confidence interval 1.309–11.604).

Conclusions

Our study suggested RSIS with varying severity of parent artery atherosclerosis exhibits distinctive clinical and neuroimaging characteristics, with low-grade MCA atherosclerosis associating with higher cerebral small vessel disease burden and worse prognosis.

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小血管疾病负担和近期皮层下缺血性脑卒中的预后因母动脉粥样硬化而异。

背景和目的：母动脉粥样硬化是近期皮层下缺血性卒中（RSIS）的重要病因。然而，目前还缺乏对不同程度的母动脉粥样硬化引起的 RSIS 的比较：回顾性审查了 2015 年至 2017 年期间从我们的多中心队列（均为三级中心）中收集的卒中成像包研究的前瞻性数据。将定义为皮质动脉区域内单个临床相关弥散加权成像阳性病变的RSIS患者分为三个亚组：（1）磁共振血管造影和高分辨率磁共振成像（HR-MRI）显示大脑中动脉（MCA）正常；（2）MCA低级别动脉粥样硬化（正常或2级）。对各分组的临床和成像结果进行比较：共纳入 239 例患者（中位年龄 60.0 [52.0-67.0] 岁，72% 为男性），包括 140 例正常 MCA 患者、64 例低级 MCA 动脉粥样硬化患者和 35 例狭窄闭塞性 MCA 动脉粥样硬化患者。MCA狭窄闭塞性动脉粥样硬化患者的梗死体积最大。低级MCA动脉粥样硬化与脑微小出血、基底节更严重的血管周围间隙和更高的脑小血管疾病总负担独立相关。低度 MCA 动脉粥样硬化是 90 天功能依赖的独立决定因素（几率比 3.897；95% 置信区间 1.309-11.604）：我们的研究表明，母动脉粥样硬化严重程度不同的RSIS表现出不同的临床和神经影像学特征，低级别MCA粥样硬化与较高的脑小血管疾病负担和较差的预后有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Neurology 医学-临床神经学

CiteScore

9.70

自引率

2.00%

发文量

418

审稿时长

1 months

期刊介绍： The European Journal of Neurology is the official journal of the European Academy of Neurology and covers all areas of clinical and basic research in neurology, including pre-clinical research of immediate translational value for new potential treatments. Emphasis is placed on major diseases of large clinical and socio-economic importance (dementia, stroke, epilepsy, headache, multiple sclerosis, movement disorders, and infectious diseases).