Cerebral small vessel disease and stroke: Linked by stroke aetiology, but not stroke lesion location or size
Christoph Sperber1, Arsany Hakim2, Laura Gallucci1
1Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
Insights
Cerebral small vessel disease (SVD) is linked to cardioembolic stroke in older adults, but not specific lesion locations. Advanced age may explain the association between SVD and stroke outcomes.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroimaging
Background:
- Cerebral small vessel disease (SVD) is associated with adverse stroke outcomes, vascular dementia, and cognitive deficits.
- The precise mechanisms linking SVD to stroke remain unclear.
- This study explores SVD's relationship with stroke causes and lesion characteristics.
Purpose of the Study:
- To investigate the association between SVD burden and stroke aetiology.
- To examine the relationship between SVD burden and stroke lesion anatomy.
- To determine if SVD influences stroke characteristics in patients with anterior circulation ischemic stroke.
Main Methods:
- Retrospective observational study of 859 patients with first-ever, non-SVD anterior circulation ischemic stroke.
- Assessment of SVD burden using MRI imaging markers.
- Evaluation of stroke aetiology and lesion anatomy via topographical statistical mapping and Bayesian statistics.
Main Results:
- Higher SVD burden correlated with cardioembolic stroke aetiology.
- Associations between SVD burden and stroke aetiology were not significant after controlling for age.
- No significant association was found between SVD burden and specific stroke lesion anatomy or size.
Conclusions:
- In patients with high SVD burden, cardioembolic aetiology is a more likely cause of non-SVD stroke.
- Advanced age, a common risk factor, may explain the link between SVD and stroke.
- SVD burden does not correlate with specific stroke lesion locations.
Background:
Cerebral small vessel disease (SVD) has previously been associated with worse stroke outcome, vascular dementia, and specific post-stroke cognitive deficits. The underlying causal mechanisms of these associations are not yet fully understood. We investigated whether a relationship between SVD and certain stroke aetiologies or a specific stroke lesion anatomy provides a potential explanation.
Methods:
In a retrospective observational study, we examined 859 patients with first-ever, non-SVD anterior circulation ischemic stroke (age = 69.0±15.2). We evaluated MRI imaging markers to assess an SVD burden score and mapped stroke lesions on diffusion-weighted MRI. We investigated the association of SVD burden with i) stroke aetiology, and ii) lesion anatomy using topographical statistical mapping.
Results:
With increasing SVD burden, stroke of cardioembolic aetiology was more frequent (ρ = 0.175; 95 %-CI = 0.103;0.244), whereas cervical artery dissection (ρ = -0.143; 95 %-CI = -0.198;-0.087) and a patent foramen ovale (ρ = -0.165; 95 %-CI = -0.220;-0.104) were less frequent stroke etiologies. However, no significant associations between SVD burden and stroke aetiology remained after additionally controlling for age (all p>0.125). Lesion-symptom-mapping and Bayesian statistics showed that SVD burden was not associated with a specific stroke lesion anatomy or size.
Conclusions:
In patients with a high burden of SVD, non-SVD stroke is more likely to be caused by cardioembolic aetiology. The common risk factor of advanced age may link both pathologies and explain some of the existing associations between SVD and stroke. The SVD burden is not related to a specific stroke lesion location.
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