Coexistent cerebral small vessel disease and multiple infarctions predict recurrent stroke

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.