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Published on: April 23, 2021
Association of White Matter Hyperintensities With Short-Term Outcomes in Patients With Minor Cerebrovascular Events
Charlotte Zerna1, Amy Y X Yu2, Jayesh Modi2
1From the Department of Clinical Neurosciences (C.Z., A.Y.X.Y., S.K.P, J.I.C., E.E.S., S.B.C.) and the Hotchkiss Brain Institute (E.E.S., S.B.C.), University of Calgary, Alberta, Canada; and Medanta - The Medicity Hospital, Gurgaon, India (J.M.). charlotte.zerna@ucalgary.ca.
Background And Purpose:
White matter lesions (WML) are associated with cognitive decline, increased stroke risk, and disability in old age. We hypothesized that superimposed acute cerebrovascular occlusion on chronic preexisting injury (leukoaraiosis) leads to worse outcome after minor cerebrovascular event, both using quantitative (volumetric) and qualitative (Fazekas scale) assessment, as well as relative total brain volume.
Methods:
WML volume assessment was performed in 425 patients with high-risk transient ischemic attack (TIA; motor/speech deficits >5 minutes) or minor strokes from the CATCH study (CT and MRI in the Triage of TIA and Minor Cerebrovascular Events to Identify High Risk Patients). Complete baseline characteristics and outcome assessment were available in 412 patients. Primary outcome was disability at 90 days, defined as modified Rankin Scale score of >1. Secondary outcomes were stroke progression, TIA recurrence, and stroke recurrence. Analysis was performed using descriptive statistics and regression models including interaction terms.
Results:
Median age was 69 years, 39.8% were female. Sixty-two patients (15%) had unfavorable outcome with disability at 90 days (modified Rankin Scale score >1). Higher Fazekas scores were strongly correlated with higher WML volume (r=0.79). Both higher Fazekas score and higher WMH volume were associated with disability at 90 days in univariate regression (odds ratio 1.22; 95% confidence interval, 1.04-1.43 and odds ratio, 1.25 per milliliter increase; 95% confidence interval, 1.02-1.54, respectively) but not with stroke progression, TIA recurrence, or stroke recurrence. In multivariable-adjusted analyses, additive interaction terms were associated with unfavorable outcome (adjusted odds ratio 3.99, 95% confidence interval, 1.87-8.49).
Conclusions:
Our data suggest that quantitative and qualitative WML assessments are highly correlated and comparable in TIA/minor stroke patients. WML burden is associated with short-term outcome of patients with good prestroke function in the presence of intracranial stenosis/occlusion.
Insights
White matter lesions (WML) significantly predict poor outcomes in patients with transient ischemic attack (TIA) or minor stroke. Both quantitative and qualitative WML assessments effectively identify patients at higher risk for disability.
Area of Science:
- Neurology
- Neuroimaging
- Vascular Neurology
Background:
- White matter lesions (WML) are linked to cognitive decline, stroke risk, and disability in older adults.
- Preexisting chronic white matter injury (leukoaraiosis) may worsen outcomes after acute cerebrovascular events.
- Assessing WML volume and severity is crucial for understanding stroke risk and prognosis.
Purpose of the Study:
- To investigate the association between white matter lesion burden and patient outcomes after transient ischemic attack (TIA) or minor stroke.
- To compare quantitative (volumetric) and qualitative (Fazekas scale) WML assessments.
- To determine if acute cerebrovascular occlusion superimposed on chronic injury impacts outcomes.
Main Methods:
- Analyzed data from 412 patients with TIA or minor stroke from the CATCH study.
- Assessed white matter lesion (WML) volume using quantitative MRI and qualitative Fazekas scale.
- Evaluated primary outcome (disability at 90 days) and secondary outcomes (stroke/TIA recurrence) using regression models.
Main Results:
- Higher Fazekas scores strongly correlated with increased WML volume (r=0.79).
- Both higher Fazekas scores and WML volume were associated with 90-day disability in univariate analysis.
- Multivariable analysis revealed an additive interaction associated with unfavorable outcomes (aOR 3.99).
Conclusions:
- Quantitative and qualitative WML assessments are highly correlated and comparable in TIA/minor stroke patients.
- WML burden is a significant predictor of short-term outcomes in patients with intracranial stenosis/occlusion.
- WML assessment aids in identifying high-risk patients for TIA and minor stroke.
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