Cerebral Microbleeds and Early Recurrent Stroke After Transient Ischemic Attack

Lim, Jae Sung; Hong, Kyung Soon; Kim, Gyeong Moon; Bang, Oh Young; Bae, Hee‐Joon; Kwon, Hyung‐Min; Park, Jong‐Moo; Lee, Jun Young; Rha, Joung Ho; Koo, Jaseong; Yu, Kyung Ho; Seo, Woo Keun; Lee, Kyung Bok; Lee, Yong Seok

doi:10.1001/jamaneurol.2014.3958

Cited by 49 publications

(32 citation statements)

References 40 publications

(9 reference statements)

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“…Previous studies showed that certain CSVDs such as HWHs, CMBs, and ALIs were independent predictors for a poor outcome after index stroke2122 or the long-term fatal outcome 11232425. However, there has been no information on the impact of the total burden of CSVDs on clinical outcomes despite various types of CSVDs commonly coexisting and the clinical outcome possibly being determined by their combined effect.…”

Section: Discussionmentioning

confidence: 99%

Total Cerebral Small-Vessel Disease Score is Associated with Mortality during Follow-Up after Acute Ischemic Stroke

et al. 2017

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Background and PurposeThe recently developed total cerebral small-vessel disease (CSVD) score might appropriately reflect the total burden or severity of CSVD. We investigated whether the total CSVD score is associated with long-term outcomes during follow-up in patients with acute ischemic stroke.MethodsIn total, 1,096 consecutive patients with acute ischemic stroke who underwent brain magnetic resonance imaging were enrolled. We calculated the total CSVD score for each patient after determining the burden of cerebral microbleeds (CMBs), high-grade white-matter hyperintensities (HWHs), high-grade perivascular spaces (HPVSs), and asymptomatic lacunar infarctions (ALIs). We recorded the date and cause of death for all of the patients using data from the Korean National Statistical Office. We compared the long-term mortality rate with the total CSVD score using Cox proportional-hazards models.ResultsCMBs were found in 26.8% of the subjects (294/1,096), HWHs in 16.4% (180/1,096), HPVSs in 19.3% (211/1,096), and ALIs in 38.0% (416/1,096). After adjusting for age, sex, and variables that were significant at p<0.1 in the univariate analysis, the total CSVD score was independently associated with long-term death from all causes [hazard ratio (HR)=1.18 per point, 95% confidence interval (CI)=1.07–1.30], ischemic stroke (HR=1.20 per point, 95% CI=1.01–1.42), and hemorrhagic stroke (HR=2.05 per point, 95% CI=1.30–3.22), but not with fatal cardiovascular events (HR=1.17 per point, 95% CI=0.82–1.67).ConclusionsThe total CSVD score is a potential imaging biomarker for predicting mortality during follow-up in patients with acute ischemic stroke.

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Section: Discussionmentioning

confidence: 99%

Total Cerebral Small-Vessel Disease Score is Associated with Mortality during Follow-Up after Acute Ischemic Stroke

et al. 2017

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“…In patients with SVD, diffuse hypoperfusion and long-standing hypertension, which commonly leads to lipohyalinosis, are most well-known causes of it. [16, 17] In this condition, cerebral auto-regulation and compensatory collateral blood flow are impaired. [18, 19] Thus, a minor ischemic insult could cause symptomatic stroke events.…”

Section: Discussionmentioning

confidence: 99%

The presence and severity of cerebral small vessel disease increases the frequency of stroke in a cohort of patients with large artery occlusive disease

et al. 2017

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BackgroundCerebral small vessel disease (SVD) commonly coexists with large artery atherosclerosis (LAA).AimWe evaluate the effect of SVD on stroke recurrence in patients for ischemic stroke with LAA.MethodsWe consecutively collected first-ever ischemic stroke patients who were classified as LAA mechanism between Jan 2010 and Dec 2013. Univariate and multivariate Cox analyses were performed to evaluate the association between the 2-year recurrence and demographic, clinical, and radiological factors. To evaluate the impact of SVD and its components on recurrent stroke, we used the Kaplan-Meier analysis. SVD was defined as the presence of severe white matter hyperintensity (WMH) or old lacunar infarction (OLI) or cerebral microbleeds (CMB). We also compared frequency and burden of SVD among recurrent stroke groups with different mechanisms.ResultsAmong a total of 956 participants, 92 patients had recurrent events. Recurrence group showed a higher frequency of severe WMH, OLI, asymptomatic territorial infarction, and severe stenosis on the relevant vessel in multivariate analysis. The impact of SVD and its components on recurrent stroke was significant in any ischemic recurrent stroke, and the presence of SVD was continuously important in stroke recurrence regardless of its mechanism, including recurrent LAA stroke, recurrent small vessel occlusion stroke, and even recurrent cardioembolic stroke. Additionally, the recurrence rate increased in dose-response manner with the increased number of SVD components.ConclusionsCerebral SVD is associated with recurrent stroke in patients with LAA. Additionally, it may affect any mechanisms of recurrent stroke and even with a dose response manner.

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“…11–13 The presence of CMBs is considered a strong predictor of future stroke, particularly haemorrhagic stroke 1415 There is evidence that large artery atherosclerosis may be associated with CMBs, but the results are controversial.…”

Section: Introductionmentioning

confidence: 99%

Association between large artery atherosclerosis and cerebral microbleeds: a systematic review and meta-analysis

2017

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ObjectiveThe aim of this systematic review and meta-analysis was to provide evidence that biomarkers of large artery atherosclerosis, including arterial stenosis and greater carotid intima-media thickness (cIMT), may serve as clinical markers of subclinical haemorrhage-prone cerebral small vessel disease, reflected by cerebral microbleeds (CMBs).MethodsWe searched PubMed, MEDLINE, Web of Science, EMBASE and the Cochrane Library to identify relevant studies published before 1 July 2016. The association between arterial stenosis and CMBs was estimated by the OR and 95% CI. The association of cIMT and CMBs was calculated using the standardised mean difference (SMD). Heterogeneity and publication bias were explored.Results8 studies including a total of 7160 participants were pooled in the meta-analysis. 6 of the included studies were cross-sectional, except that 2 were prospective. We found a significant association between arterial stenosis >50% and the presence of CMBs (OR 1.95, 95% CI 1.13 to 3.36, I2=56.1%). A fixed-effects model suggested that patients with CMBs were more likely to have a greater cIMT (SMD 0.20, 95% CI 0.11 to 0.28, I2=24.7%).ConclusionsThis systematic review and meta-analysis found that there is a relationship between large artery atherosclerosis and CMBs. Future studies are needed to confirm the impact of atherosclerosis on the CMBs, which may have potential therapeutic implications.

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Cerebral Microbleeds and Early Recurrent Stroke After Transient Ischemic Attack

Cited by 49 publications

References 40 publications

Total Cerebral Small-Vessel Disease Score is Associated with Mortality during Follow-Up after Acute Ischemic Stroke

Total Cerebral Small-Vessel Disease Score is Associated with Mortality during Follow-Up after Acute Ischemic Stroke

The presence and severity of cerebral small vessel disease increases the frequency of stroke in a cohort of patients with large artery occlusive disease

Association between large artery atherosclerosis and cerebral microbleeds: a systematic review and meta-analysis

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