Clinical Relevance of 'Cap' and 'Track' Development after Recent Small Subcortical Infarct.

IF 8.1 1区医学 Q1 CLINICAL NEUROLOGY Annals of Neurology Pub Date : 2025-01-17 DOI:10.1002/ana.27182

Yajun Cheng, Carmen Arteaga-Reyes, Una Clancy, Daniela Jaime Garcia, Maria Del C Valdés Hernández, Michael J Thrippleton, Michael S Stringer, Gordon W Blair, Stewart Wiseman, Francesca M Chappell, Junfang Zhang, Xiaodi Liu, Angela C C Jochems, Susana Muñoz Maniega, Eleni Sakka, Mark E Bastin, Rosalind Brown, Caroline M J Loos, Stephen D J Makin, Ming Liu, Bo Wu, Fergus N Doubal, Joanna M Wardlaw

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引用次数: 0

Abstract

Objective: After a recent small subcortical infarct (RSSI), some patients develop perilesional or remote hyperintensities ('caps/tracks') to the index infarct on T2/FLAIR MRI. However, their clinical relevance remains unclear. We investigated the clinicoradiological correlates of 'caps/tracks', and their impact on long-term outcomes following RSSI.

Methods: We identified participants with lacunar stroke and MRI-confirmed RSSI from 3 prospective studies. At baseline, we collected risk factors, RSSI characteristics, small vessel disease (SVD) features, and microstructural integrity on diffusion imaging. Over 1-year, we repeated MRI and recorded 'caps/tracks' blinded to other data. We evaluated predictors of 'caps/tracks', and their association with 1-year functional (modified Rankin Scale score ≥2), mobility (Timed Up-and-Go), cognitive outcomes (Montreal Cognitive Assessment [MoCA] score <26), and recurrent cerebrovascular events (stroke/transient ischemic attack/incident infarct) using multivariable regression.

Results: Among 185 participants, 93 (50.3%) developed 'caps/tracks' first detected at median 198 days after stroke. 'Caps/tracks' were independently predicted by baseline factors: larger RSSI, RSSI located in white matter, higher SVD score, and higher mean diffusivity in normal-appearing white matter (odds ratio [OR] [95% confidence interval {CI}], 1.15 [1.07-1.25], 6.01 [2.80-13.57], 1.77 [1.31-2.44], 1.42 [1.01-2.03]). At 1 year, 'cap/track' formation was associated with worse functional outcome (OR: 3.17, 95% CI: 1.28-8.22), slower gait speed (β: 0.13, 95% CI: 0.01-0.25), and recurrent cerebrovascular events (hazard ratio [HR]: 2.05, 95% CI: 1.05-4.02), but not with cognitive impairment.

Interpretation: 'Caps/tracks' after RSSI are associated with worse clinical outcomes, and may reflect vulnerability to progressive SVD-related injury. Reducing 'caps/tracks' may offer early efficacy markers in trials aiming to improve outcome after lacunar stroke. ANN NEUROL 2025.

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近期皮质下小梗死后“Cap”和“Track”发展的临床意义

目的：在最近的小皮质下梗死（RSSI）后，一些患者在T2/FLAIR MRI上出现病灶周围或远端高信号（“帽状/轨迹”）。然而，它们的临床意义尚不清楚。我们调查了“caps/tracks”的临床放射学相关性，以及它们对RSSI后长期预后的影响。方法：我们从3项前瞻性研究中确定了腔隙性卒中和mri证实的RSSI患者。基线时，我们收集危险因素、RSSI特征、小血管病变（SVD）特征和弥散成像显微结构完整性。在1年多的时间里，我们重复了MRI并记录了“帽/轨迹”，对其他数据不知情。我们评估了“caps/tracks”的预测因子，以及它们与1年功能（改良Rankin量表评分≥2）、移动性（Timed Up-and-Go）、认知结果（蒙特利尔认知评估[MoCA]评分）的关联。结果：185名参与者中，93名（50.3%）在中风后198天首次检测到“caps/tracks”。“Caps/tracks”可通过基线因素独立预测：RSSI较大，RSSI位于白质，SVD评分较高，正常白质的平均扩散率较高（比值比[OR][95%可信区间{CI}]， 1.15[1.07-1.25], 6.01[2.80-13.57], 1.77[1.31-2.44], 1.42[1.01-2.03]）。1年后，“帽/径”形成与较差的功能结局（OR: 3.17, 95% CI: 1.28-8.22）、较慢的步态速度（β: 0.13, 95% CI: 0.01-0.25）和复发性脑血管事件（风险比[HR]: 2.05, 95% CI: 1.05-4.02）相关，但与认知障碍无关。解释：RSSI后的“Caps/tracks”与较差的临床结果相关，并且可能反映了对进行性svd相关损伤的易感性。减少“上限/轨迹”可能在旨在改善腔隙性卒中后预后的试验中提供早期疗效标记。Ann neurol 2025。

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来源期刊

Annals of Neurology 医学-临床神经学

CiteScore

18.00

自引率

1.80%

发文量

270

审稿时长

3-8 weeks

期刊介绍： Annals of Neurology publishes original articles with potential for high impact in understanding the pathogenesis, clinical and laboratory features, diagnosis, treatment, outcomes and science underlying diseases of the human nervous system. Articles should ideally be of broad interest to the academic neurological community rather than solely to subspecialists in a particular field. Studies involving experimental model system, including those in cell and organ cultures and animals, of direct translational relevance to the understanding of neurological disease are also encouraged.