Extensive white matter changes predict stroke recurrence up to 5 years after a first-ever ischemic stroke

Area of Science:

• Neurology
• Radiology
• Epidemiology

Background:

• White matter changes (WMCs) are linked to small vessel disease (SVD) and negatively impact cognition, mood, and daily functioning.
• The association between severe WMCs and recurrent ischemic stroke risk requires further investigation.

Purpose of the Study:

• To determine if severe WMCs are a risk factor for recurrent ischemic stroke.
• To evaluate the long-term prognosis of patients with severe WMCs after a first-ever ischemic stroke.

Main Methods:

• A cohort of 320 patients with first-ever ischemic stroke was followed for 12 years.
• White matter changes (WMCs) were assessed using MRI and categorized as absent-to-moderate or severe.
• Multivariate Cox regression analysis was employed to identify independent predictors of stroke recurrence, controlling for confounding factors.

Main Results:

• Recurrent stroke occurred in 23.8% of patients at 5 years and 39.7% at 12 years.
• Severe WMCs were associated with a higher 5-year recurrence risk (39.1%) compared to absent-to-moderate WMCs (24.5%).
• Independent predictors of 5-year recurrent stroke included severe WMCs, atrial fibrillation, hypertension, and peripheral arterial disease.

Conclusions:

• Severe WMCs predict stroke recurrence within 5 years after an initial ischemic stroke.
• WMCs can serve as a marker for SVD, summarizing the impact of risk factors on the brain's small vessels.
• These findings highlight the poor long-term prognosis associated with cerebral SVD.