Cerebral Small Vessel Disease MRI Features Do Not Improve the Prediction of Stroke Outcome

Coutureau, Juliette; Asselineau, Julien; Paul, Perez; Kuchcinski, Grégory; Sagnier, Sharmila; Renou, Pauline; Munsch, Fanny; Lopes, Renaud; Hénon, Hilde; Bordet, Régis; Denis, Vincent; Sibon, Igor; Tourdias, Thomas

doi:10.1212/wnl.0000000000011208

Cited by 16 publications

(23 citation statements)

References 47 publications

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“…Although other studies have found no incremental discrimination improvement of cerebral small‐vessel disease markers for functional outcome, 35 our study showed that incorporation of those markers modestly improves established mortality risk scores. A review regarding this topic concluded that neuroimaging markers including CBI were poor prognostic markers for several outcomes including long‐term functional outcome 36 .…”

Section: Discussioncontrasting

confidence: 87%

Chronic cerebral infarctions and white matter lesions link to long‐term survival after a first ischemic event: A cohort study

Schilter

Epstein

Vynckier

et al. 2022

Journal of Neuroimaging

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Background and Purpose: To investigate the association of different phenotypes, count, and locations of chronic covert brain infarctions (CBI) with long-term mortality in patients with first-ever manifest acute ischemic stroke (AIS) or transient ischemic attack (TIA).Additionally, to analyze their potential interaction with white matter hyperintensities (WMH) and predictive value in addition to established mortality scores. Methods: Single-center cohort study including consecutive patients with first-ever AIS or TIA with available MRI imaging from January 2015 to December 2017. Blinded raters adjudicated CBI phenotypes and WMH (age-related white matter changes score) according to established definitions. We compared Cox regression models including prespecified established predictors of mortality using Harrell's C and likelihood ratio tests. Results: A total of 2236 patients (median [interquartile range] age: 71 [59-80] years, 43% female, National Institutes of Health Stroke Scale: 2 [1-6], median follow-up: 1436 days, 21% death during follow-up) were included. Increasing WMH (per point adjusted Hazard Ratio [aHR] = 1.29 [1.14-1.45]), but not CBI (aHR = 1.21 [0.99-1.49]), were independently associated with mortality. Neither CBI phenotype, count, nor location was associated with mortality and there was no multiplicative interaction between CBI and WMH (p > .1). As compared to patients without CBI or WMH, patients with moderate or severe WMH and additional CBI had the highest hazards of death (aHR = 1.62 [1.23-2.13]). The Cox regression model including CBI and WMH had a small but significant increment in Harrell's C when compared to the model including 14 clinical variables (0.831 vs. 0.827, p < .001).

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Section: Discussioncontrasting

confidence: 87%

Chronic cerebral infarctions and white matter lesions link to long‐term survival after a first ischemic event: A cohort study

Schilter

Epstein

Vynckier

et al. 2022

Journal of Neuroimaging

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“…Similarly, Bu and colleagues [ 61 ] could not identify a connection between SVD radiological markers, such as WMHs, lacunes, and EPVSs and early stroke outcome. Apart from that, in an attempt to evaluate the predictive value of the “brain before stroke”, Coutureau and colleagues [ 72 ] examined whether cerebral SVD parameters, such as WMHs, lacunes, EPVSs, CMBs, cerebral atrophy and the total SVD score would add information to the prediction of early stroke outcome compared to validated predictors, such as age and baseline NIHSS. Even though all cerebral SVD parameters were associated with patient outcome they did not provide significant improvement of early stroke outcome prediction.…”

Section: Discussionmentioning

confidence: 99%

The Clinical Utility of Leukoaraiosis as a Prognostic Indicator in Ischemic Stroke Patients

Christidi

Tsiptsios

Sousanidou

et al. 2022

Neurology International

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Stroke constitutes a major cause of functional disability with increasing prevalence among adult individuals. Thus, it is of great importance for both clinicians and stroke survivors to be provided with a timely and accurate prognostication of functional outcome. A great number of biomarkers capable of yielding useful information regarding stroke patients’ recovery propensity have been evaluated so far with leukoaraiosis being among them. Literature research of two databases (MEDLINE and Scopus) was conducted to identify all relevant studies published between 1 January 2012 and 25 June 2022 that dealt with the clinical utility of a current leukoaraiosis as a prognostic indicator following stroke. Only full-text articles published in English language were included. Forty-nine articles have been traced and are included in the present review. Our findings highlight the prognostic value of leukoaraiosis in an acute stroke setting. The assessment of leukoaraiosis with visual rating scales in CT/MRI imaging appears to be able to reliably provide important insight into the recovery potential of stroke survivors, thus significantly enhancing stroke management. Yielding additional information regarding both short- and long-term functional outcome, motor recovery capacity, hemorrhagic transformation, as well as early neurological deterioration following stroke, leukoaraiosis may serve as a valuable prognostic marker poststroke. Thus, leukoaraiosis represents a powerful prognostic tool, the clinical implementation of which is expected to significantly facilitate the individualized management of stroke patients.

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“…These findings are consistent with what recently observed in an independent cohort of first-ever stroke patients, although older than those included in our series. 25 Therefore, although subclinical vascular lesions are common incidental findings on MRI brain scans in young patients with ischemic stroke their clinical and therapeutic significance remains uncertain.…”

Section: Discussionmentioning

confidence: 99%

Subclinical Vascular Brain Lesions in Young Adults With Acute Ischemic Stroke

Giuli

Grassi

Besana

et al. 2022

Stroke

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Background and Purpose: Subclinical vascular brain lesions are highly prevalent in elderly patients with stroke. Little is known about predisposing factors and their impact on long-term outcome of patients with stroke at a young age. Methods: We quantified magnetic resonance-defined subclinical vascular brain lesions, including lacunes and white matter hyperintensities, perivascular spaces and cerebral microbleeds, and assessed total small-vessel disease (SVD) score in patients with first-ever acute ischemic stroke aged 18 to 45 years, and followed them up, as part of the multicentre Italian Project on Stroke in Young Adults. The primary end point was a composite of ischemic stroke, transient ischemic attack, myocardial infarction, or other arterial events. We assessed the predictive accuracy of magnetic resonance features and whether the addition of these markers improves outcome prediction over a validated clinical tool, such as the Italian Project on Stroke in Young Adults score. Results: Among 591 patients (males, 53.8%; mean age, 37.5±6.4 years), 117 (19.8%) had subclinical vascular brain lesions. Family history of stroke was associated with lacunes (odds ratio, 2.24 [95% CI, 1.30–3.84]) and total SVD score (odds ratio, 2.06 [95% CI, 1.20–3.53] for score≥1), hypertension with white matter hyperintensities (odds ratio, 2.29 [95% CI, 1.22–4.32]). After a median follow-up of 36.0 months (25th–75th percentile, 38.0), lacunes and total SVD score were associated with primary end point (hazard ratio, 2.13 [95% CI, 1.17–3.90] for lacunes; hazard ratio, 2.17 [95% CI, 1.20–3.90] for total SVD score ≥1), and the secondary end point brain ischemia (hazard ratio, 2.55 [95% CI, 1.36–4.75] for lacunes; hazard ratio, 2.61 [95% CI, 1.42–4.80] for total SVD score ≥1). The predictive performances of the models, including magnetic resonance features were comparable to those of the random model. Adding individual magnetic resonance features to the Italian Project on Stroke in Young Adults score did not improve model prediction. Conclusions: Subclinical vascular brain lesions affect ≈2 in 10 young adults with ischemic stroke. Although lacunes and total SVD score are associated with thrombotic recurrence, they do not improve accuracy of outcome prediction over validated clinical predictors.

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Cerebral Small Vessel Disease MRI Features Do Not Improve the Prediction of Stroke Outcome

Cited by 16 publications

References 47 publications

Chronic cerebral infarctions and white matter lesions link to long‐term survival after a first ischemic event: A cohort study

Chronic cerebral infarctions and white matter lesions link to long‐term survival after a first ischemic event: A cohort study

The Clinical Utility of Leukoaraiosis as a Prognostic Indicator in Ischemic Stroke Patients

Subclinical Vascular Brain Lesions in Young Adults With Acute Ischemic Stroke

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