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Intracranial Atherosclerosis Coexisting With White Matter Hyperintensities May Predict Unfavorable Functional Outcome
Haiyan Liu1,2, Yuehua Pu1, Yilong Wang1,3,4,5
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Insights
White matter hyperintensities (WMH) combined with intracranial atherosclerosis (ICAS) predict poor functional outcomes one year after stroke. However, this combination does not increase the risk of stroke recurrence.
Area of Science:
- Neurology
- Radiology
- Epidemiology
Background:
- White matter hyperintensities (WMH) are common findings on brain imaging.
- Intracranial atherosclerosis (ICAS) is a significant cause of stroke globally.
- The combined impact of WMH and ICAS on stroke outcomes requires further investigation.
Purpose of the Study:
- To evaluate the effect of baseline WMH on 1-year stroke recurrence.
- To assess the impact of baseline WMH on functional outcomes in patients with ICAS.
Main Methods:
- Analysis of 2,076 patients from the Chinese IntraCranial AtheroSclerosis (CICAS) study.
- Diagnosis of ICAS and WMH using baseline magnetic resonance angiography.
- Primary outcomes: stroke recurrence and unfavorable functional outcome (modified Rankin Scale score 3-6) at 1 year.
Main Results:
- Patients with both WMH and ICAS showed a significantly higher risk of unfavorable functional outcomes (OR 2.046, p=0.0058).
- ICAS alone was also associated with an increased risk of unfavorable functional outcomes (OR 1.920, p=0.0421).
- No significant difference in stroke recurrence risk was observed among the four groups (WMH/ICAS combinations).
Conclusions:
- The coexistence of ICAS and WMH is a predictor of unfavorable functional outcomes at one year post-stroke.
- WMH and ICAS do not appear to influence the risk of stroke recurrence.
- These findings highlight the importance of considering WMH in stroke patients with ICAS for prognostication.
Abstract:
Background and Purpose: This study aimed to assess the effect of baseline white matter hyperintensities (WMH) on 1-year stroke recurrence and the functional outcome for patients with intracranial atherosclerosis (ICAS). Methods: We analyzed 2,076 patients who were enrolled in the Chinese IntraCranial AtheroSclerosis (CICAS) study. ICAS and WMH were diagnosed by baseline magnetic resonance angiography. The primary outcomes were stroke recurrence and unfavorable functional outcome (modified Rankin Scale score 3-6) at 1 year. Results: Of the 2,076 patients included in this study, 1,370 (65.99%) were men, and the mean age was 61.70 years. In total, 224 (10.79%) patients had no WMH and no ICAS, 922 (44.41%) patients had WMH and no ICAS, 157 (7.56%) patients had ICAS and no WMH, and 773 (37.24%) had both WMH and ICAS. During the follow-up period, 87 patients had a recurrent stroke and 333 had unfavorable outcomes at 1 year. Compared to WMH (-) ICAS (-) group, the adjusted odd ratios and 95% confidence interval for unfavorable functional outcome were 0.791 (0.470-1.332; p = 0.3779) in the WMH (+) ICAS (-) group, 1.920 (1.024-3.600; p = 0.0421) in the WMH (-) ICAS (+) group, and 2.046 (1.230-3.403; p = 0.0058) in the WMH (+) ICAS (+) group. There was no significant difference in stroke recurrence risk among the four groups. Conclusion: ICAS coexisting with WMH may predict an unfavorable functional outcome at 1 year, but not stroke recurrence.
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