Association between large artery stenosis, cerebral small vessel disease and risk of ischemic stroke

Area of Science:

• Neurology
• Vascular Medicine
• Epidemiology

Background:

• Cerebrovascular diseases, including large artery stenosis (LAS) and cerebral small vessel disease (CSVD), are significant risk factors for ischemic stroke.
• Understanding the independent and combined contributions of LAS and CSVD to stroke risk is crucial for effective primary prevention.

Purpose of the Study:

• To assess the associations of LAS and CSVD with ischemic stroke risk.
• To investigate the respective and combined contributions of LAS and CSVD to stroke risk in an asymptomatic population.

Main Methods:

• Prospective population-based study (Shunyi Study) including 1,082 stroke-free participants (aged 55.9±9.1 years).
• Follow-up for incident stroke from 2013-2019 (mean 4.2 years).
• Assessment of CSVD burden using a total small vessel disease score and LAS severity via magnetic resonance angiography and carotid ultrasound; Cox regression models were used for risk estimation.

Main Results:

• During follow-up, 34 participants (3.1%) experienced ischemic stroke.
• Severe LAS (≥50% stenosis) was associated with increased stroke risk (HR=3.27).
• High CSVD burden (score 2-4) was strongly associated with increased stroke risk (HR=12.73). CSVD burden explained a larger variation in stroke risk (7.72%) compared to LAS severity (3.49%).

Conclusions:

• Both LAS and CSVD are independently associated with future ischemic stroke in asymptomatic individuals.
• High CSVD burden represents a more significant risk factor for ischemic stroke than severe LAS in this population.
• Individuals with high CSVD burden require enhanced attention in primary stroke prevention efforts.