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White matter hyperintensity burden in acute stroke patients differs by ischemic stroke subtype.
Anne-Katrin Giese1, Markus D Schirmer1, Adrian V Dalca1
1From the Department of Neurology (A.-K.G., M.D.S., K.L.D., M.N., J.R., O.W., N.S.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Program in Medical and Population Genetics (A.K.-G, J.R.), Broad Institute of MIT and Harvard; Computer Science and Artificial Intelligence Lab (M.D.S., A.V.D., R. Sridharan, P.G.), Massachusetts Institute of Technology, Cambridge; Department of Population Health Sciences (M.D.S.), German Centre for Neurodegenerative Diseases, Bonn, Germany; Athinoula A. Martinos Center for Biomedical Imaging (A.V.D., R.I., E.C.M., S.J.T.M., J.R., O.W.), Department of Radiology, Massachusetts General Hospital, Charlestown; Division of Endocrinology, Diabetes and Nutrition (H.X., P.F.M., B.D.M.), Department of Medicine, University of Maryland School of Medicine; Department of Neurology (J.W.C., S.J.K.), University of Maryland School of Medicine and Veterans Affairs Maryland Health Care System, Baltimore; Department of Neurology (E.G.-S., J.J.-C.), Neurovascular Research Group, IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autonoma de Barcelona, Spain; Institute of Biomedicine (C.J.), Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology and Rehabilitation Medicine (D.O.K., D.W.), University of Cincinnati College of Medicine, OH; KU Leuven-University of Leuven (R.L.), Department of Neurosciences, Experimental Neurology; VIB (R.L.), Vesalius Research Center, Laboratory of Neurobiology, University Hospitals Leuven, Department of Neurology, Belgium; Department of Clinical Sciences Lund (J.W., A.L.), Neurology, Lund University; Department of Neurology and Rehabilitation Medicine (A.L.), Neurology, Skåne University Hospital, Lund, Sweden; Department of Neurology (T.R., R.L.S.), Miller School of Medicine, University of Miami, The Evelyn F. McKnight Brain Institute, FL; Department of Neurology (R. Schmidt), Clinical Division of Neurogeriatrics, Medical University Graz, Austria; Institute of Cardiovascular Research (P.S.), Royal Holloway University of London, Egham, UK; Ashford and St Peter's Hospital (P.S.), UK; Department of Neurology (A.S.), Jagiellonian University Medical College, Krakow, Poland; Stroke Division (V.T.), Florey Institute of Neuroscience and Mental Health, University of Melbourne Heidelberg; Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Center for Genomic Medicine (J.R.), Massachusetts General Hospital; Henry and Allison McCance Center for Brain Health (J.R.), Boston, MA; and Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL.
White matter hyperintensity (WMH) burden varies by stroke cause in acute ischemic stroke (AIS) patients. Small artery occlusion (SAO) subtypes show the highest WMH volume, supporting the small vessel disease hypothesis.
Area of Science:
- Neurology
- Radiology
- Vascular Medicine
Background:
- White matter hyperintensities (WMH) are common in acute ischemic stroke (AIS).
- Understanding the relationship between WMH burden, vascular risk factors, and stroke etiology is crucial for targeted treatment.
- Previous studies have suggested an association, but comprehensive analysis across diverse etiologic subtypes is needed.
Purpose of the Study:
- To investigate the association between etiologic stroke subtypes, vascular risk factor profiles, and white matter hyperintensity (WMH) burden in patients with acute ischemic stroke (AIS).
- To identify independent predictors of WMH volume in AIS patients.
- To compare WMH burden across different etiological classifications of stroke.
Main Methods:
- The study analyzed data from 3,301 patients with AIS from the MRI Genetics Interface Exploration (MRI-GENIE) study.
- Stroke subtyping was performed using the Causative Classification of Ischemic Stroke (CCS) tool.
- White matter hyperintensity volume (WMHv) was quantified using a deep-learning algorithm on T2 brain MRI scans for 2,529 patients.
- Univariable and multivariable linear mixed-effects models were used to assess relationships between risk factors, WMHv, and CCS subtypes.
Main Results:
- Vascular risk factor profiles significantly differed across AIS etiologic subtypes (p < 0.001).
- Median WMHv was 5.86 cm³ and varied significantly by CCS subtype (p < 0.0001).
- Age, hypertension, prior stroke, smoking, and diabetes mellitus were independent predictors of WMHv.
- Patients with small artery occlusion (SAO) exhibited significantly higher WMHv compared to other subtypes (p < 0.001).
Conclusions:
- Vascular risk factor profiles and WMH burden differ by stroke subtype in AIS patients.
- The highest WMH lesion burden was observed in patients with SAO, supporting the small vessel hypothesis.
- These findings highlight the importance of considering stroke etiology when evaluating WMH in AIS.
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