Risk Profile of Ischemic Stroke Caused by Small-Artery Occlusion vs. Deep Intracerebral Hemorrhage
Zimo Chen1,2,3,4, Jinglin Mo1,2,3,4, Jie Xu1,2,3,4
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Insights
Small-artery occlusion (SAO) stroke and deep intracerebral hemorrhage (dICH) have distinct risk profiles. Factors like waist/height ratio and inflammation levels differentiate these stroke subtypes.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Epidemiology
Background:
- Small-artery occlusion (SAO) stroke constitutes 25% of ischemic strokes, originating from cerebral small vessel disease.
- Cerebral small vessel disease also underlies deep intracerebral hemorrhage (dICH).
- Factors differentiating SAO from dICH remain unclear.
Purpose of the Study:
- To compare the risk profiles of patients with SAO stroke and dICH.
- To identify factors contributing to the distinct pathologies of SAO and dICH.
Main Methods:
- Cross-sectional study utilizing data from the China National Stroke Registry (August 2007 - September 2008).
- Inclusion of consecutive patients diagnosed with ischemic stroke or intracerebral hemorrhage.
- Multivariable logistic regression analysis to compare risk profiles between SAO stroke and dICH subgroups.
Main Results:
- Analysis included 1,135 SAO stroke patients and 1,125 dICH patients.
- SAO stroke patients were more likely male, diabetic, with higher BMI, waist/height ratio, platelet count, and abnormal estimated glomerular filtration rate.
- dICH patients exhibited higher blood pressure, inflammation markers (WBC, hs-CRP), and HDL-c levels.
Conclusions:
- Significant differences exist in the risk profiles of SAO stroke and dICH.
- Beyond traditional markers, waist/height ratio, platelet count, inflammation, lipid profiles, and eGFR are crucial in determining arteriolosclerosis outcomes.
Abstract:
Background: Small-artery occlusion (SAO) subtype accounts for a quarter of the cases of ischemic stroke and is mainly caused by pathological changes in cerebral small vessels, which also involve in deep intracerebral hemorrhage (dICH). However, the factors that drive some cases to SAO and others to dICH remained incompletely defined. Material and Methods: This study is a cross-sectional study from the China National Stroke Registry that included consecutive patients with ischemic stroke or intracerebral hemorrhage between August 2007 and September 2008. We compared the risk profile between the two subgroups using multivariable logistic regression. Results: A total of 1,135 patients with SAO stroke and 1,125 dICH patients were included for analyses. Generally, patients with SAO stroke were more likely to be male (odds ratio = 0.74, confidence interval = 0.58-0.94) and have diabetes (0.30, 0.22-0.40), higher atherogenic lipid profiles, higher body mass index (0.96, 0.94-0.99), higher waist/height ratio (0.12, 0.03-0.48), higher platelet count (0.84, 0.77-0.91), and higher proportion of abnormal estimated glomerular filtration rate (<90, ml/min/1.73 m2) (0.77, 0.62-0.95). Conversely, patients with dICH were more likely to have higher blood pressure parameters, inflammation levels (white blood cell count: 1.61, 1.48-1.76; high sensitivity C-reactive protein: 2.07, 1.36-3.16), and high-density lipoprotein-c (1.57, 1.25-1.98). Conclusions: The risk profile between SAO stroke and dICH were different. Furthermore, despite of traditional indexes, waist/height ratio, platelet count, inflammation levels, lipid profile, and estimated glomerular filtration rate also play important roles in driving arteriolosclerosis into opposite ends.
