Cerebral Small Vessel Disease is Associated with Prehospital Delay in Acute Ischemic Stroke.

IF 3 2区医学 Q2 PERIPHERAL VASCULAR DISEASE Journal of atherosclerosis and thrombosis Pub Date : 2024-09-05 DOI:10.5551/jat.64968

Marina Masui, Takeo Sato, Motohiro Okumura, Takahiro Ishikawa, Kenichi Sakuta, Tatsushi Kokubu, Junichiro Takahashi, Tomomichi Kitagawa, Maki Tanabe, Asako Onda, Teppei Komatsu, Kenichiro Sakai, Tadashi Umehara, Hidetaka Mitsumura, Yasuyuki Iguchi

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Abstract

Aim: To determine whether the severity of cerebral small vessel disease (SVD) is associated with prehospital delay in acute ischemic stroke.

Methods: Consecutive patients with ischemic stroke were included in this study. We evaluated the SVD burden using the total SVD score. Patients were divided into 2 groups: onset-to-door time within 4.5 hours (early arrival group) and onset-to-door time over 4.5 hours (delayed arrival group). First, we assessed whether the total SVD score was related to prehospital delay using a logistic regression analysis. Second, we assessed which item of the score was independently associated with delays. Finally, we determined whether the item had a linear association with the delay.

Results: Of the 2,112 screened patients, 1,754 were enrolled in the study (1,253 males [71%]; median age, 69 years). There were 1,105 patients (63%) in the delayed arrival group. The total SVD score was independently associated with delay (OR 1.11, 95% CI 1.01-1.21, p=0.025). Among the 4 items of the score, only enlarged perivascular spaces (EPVS) in the basal ganglia was independently associated with delay (OR 1.37, 95% CI 1.05-1.80, p=0.022). A linear trend was observed between EPVS grade and delay with reference to EPVS grade 0-1 (EPVS grade 2: OR 1.22, 95% CI 0.92-1.62, p=0.170, EPVS grade 3: OR 1.69, 95% CI 1.20-2.38, p=0.002, EPVS grade 4: OR 2.17, 95% CI 1.37-3.44, p=0.001).

Conclusions: Prehospital delay in acute ischemic stroke could be associated with the severity of SVD, particularly EPVS in the basal ganglia.

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脑小血管疾病与急性缺血性卒中的院前延误有关。

目的：确定脑小血管疾病（SVD）的严重程度是否与急性缺血性卒中的院前延误有关：本研究纳入了连续的缺血性脑卒中患者。我们使用 SVD 总分评估 SVD 负担。患者分为两组：从发病到到达医院的时间在 4.5 小时之内（早期到达组）和从发病到到达医院的时间超过 4.5 小时（延迟到达组）。首先，我们使用逻辑回归分析评估了 SVD 总分是否与院前延误有关。其次，我们评估了得分中与延误独立相关的项目。最后，我们确定该项目是否与延误呈线性关系：在 2,112 名接受筛查的患者中，1,754 人被纳入研究（1,253 名男性[71%]；中位年龄 69 岁）。延迟到达组有 1,105 名患者（63%）。SVD 总分与延误有独立关联（OR 1.11，95% CI 1.01-1.21，P=0.025）。在该评分的 4 个项目中，只有基底节血管周围间隙增大（EPVS）与延迟独立相关（OR 1.37，95% CI 1.05-1.80，p=0.022）。EPVS等级与延迟之间呈线性趋势，参考EPVS等级0-1（EPVS等级2：OR 1.22，95% CI 0.92-1.62，p=0.170；EPVS等级3：OR 1.69，95% CI 1.20-2.38，p=0.002；EPVS等级4：OR 2.17，95% CI 1.37-3.44，p=0.001）：急性缺血性卒中的院前延迟可能与 SVD 的严重程度有关，尤其是基底节的 EPVS。

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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