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Coexistent cerebral small vessel disease and multiple infarctions predict recurrent stroke

Yu Tian1,2,3,4,5, Yuesong Pan1,2,3,4,5, Hongyi Yan1,2,3,4,5

  • 1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.

Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
|April 2, 2022
PubMed

Insights

Cerebral small vessel disease (CSVD) and multiple acute infarctions (MAIs) significantly increase the risk of recurrent stroke in patients with acute minor stroke or TIA. Early identification of these factors is crucial for risk stratification and management.

Area of Science:

  • Neurology
  • Vascular Neurology
  • Stroke Medicine

Background:

  • Cerebral small vessel disease (CSVD) is a common finding in patients experiencing acute minor stroke or transient ischemic attack (TIA).
  • The number of acute infarctions is another critical factor influencing stroke recurrence.
  • Understanding the combined impact of CSVD and infarction burden is essential for predicting outcomes.

Purpose of the Study:

  • To investigate the association between different statuses of cerebral small vessel disease (CSVD) and the number of acute infarctions with the risk of recurrent stroke.
  • To identify specific patient subgroups at higher risk for stroke recurrence after an initial event.

Main Methods:

  • A post hoc analysis of the CHANCE trial involving 886 patients with acute minor stroke and TIA.
  • CSVD burden was categorized as non-CSVD (0 score) and CSVD (1-4 score).
  • Infarction numbers were classified as multiple acute infarctions (MAIs ≥2), single acute infarction (SAI =1), and non-acute infarction (NAI =0).
  • Multivariable Cox regression models were used to analyze the risk of primary and secondary outcomes, including recurrent stroke, ischemic stroke, composite vascular events (CVE), and TIA.

Main Results:

  • Recurrent stroke occurred in 10.5% of patients within 1 year.
  • Patients with both CSVD and MAIs had a 9.56-fold increased risk of recurrent stroke compared to those with non-CSVD and NAI (HR 9.560, p=0.028).
  • Similar associations were observed for recurrent ischemic stroke and CVE.

Conclusions:

  • CSVD status and the number of acute infarctions are significant predictors of recurrent stroke in patients with acute minor stroke and TIA.
  • The combination of CSVD and multiple acute infarctions represents a particularly high-risk profile for stroke recurrence.
Abstract

Keywords:
Cerebral small vascular diseaseInfarction numberIschaemic strokeRecurrent strokeTIA

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