Cerebral small vessel disease or intracranial large vessel atherosclerosis may carry different risk for future strokes

Chen, Huimin; Pan, Yuesong; Zong, Lixia; Jing, Jing; Meng, Xia; Xu, Yuyuan; H, Yan; Zhao, Xingquan; Liu, Liping; Li, Hao; Wang, Yongjun; Wang, Yilong

doi:10.1136/svn-2019-000305

Cited by 28 publications

(16 citation statements)

References 26 publications

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“…The findings of this study are consistent with those of other recently reported trials ( 13 , 15 ), which indicated that the presence of WMH on baseline magnetic resonance imaging is not independently associated with an increased risk of stroke recurrence in patients with ICAS. The coexistence of intracranial atherosclerosis with changes in white matter may predict an unfavorable functional outcome at 1 year.…”

Section: Discussionsupporting

confidence: 93%

“…A study from the SAMMPRIS trial showed that the presence of SVD on baseline magnetic resonance imaging was not independently associated with an increased risk of stroke in patients with ICAS ( 13 ). Data from the CHANCE trial found that SVD was associated with more disability and bleeding events and that ICAS is associated with an increased risk of stroke and disability in patients with minor stroke and TIA at 3 months, which implies that SVD and ICAS may represent different vascular pathologies and play distinct roles in stroke outcomes ( 15 ).…”

Section: Discussionmentioning

confidence: 99%

“…A study from the Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial, indicated that SVD and ICAS may have different levels of risk for future strokes. SVD was associated with more disability and bleeding events, and ICAS was associated with an increased risk of stroke and disability in patients with minor stroke and TIA at 3 months ( 15 ).…”

Section: Introductionmentioning

confidence: 99%

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Intracranial Atherosclerosis Coexisting With White Matter Hyperintensities May Predict Unfavorable Functional Outcome in Patients With Acute Cerebral Ischemia

Liu

Wang

et al. 2020

Front. Neurol.

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Background and Purpose: This study aimed to assess the effect of baseline white matter hyperintensities (WMH) on 1-year stroke recurrence and the functional outcome for patients with intracranial atherosclerosis (ICAS).Methods: We analyzed 2,076 patients who were enrolled in the Chinese IntraCranial AtheroSclerosis (CICAS) study. ICAS and WMH were diagnosed by baseline magnetic resonance angiography. The primary outcomes were stroke recurrence and unfavorable functional outcome (modified Rankin Scale score 3–6) at 1 year.Results: Of the 2,076 patients included in this study, 1,370 (65.99%) were men, and the mean age was 61.70 years. In total, 224 (10.79%) patients had no WMH and no ICAS, 922 (44.41%) patients had WMH and no ICAS, 157 (7.56%) patients had ICAS and no WMH, and 773 (37.24%) had both WMH and ICAS. During the follow-up period, 87 patients had a recurrent stroke and 333 had unfavorable outcomes at 1 year. Compared to WMH (–) ICAS (–) group, the adjusted odd ratios and 95% confidence interval for unfavorable functional outcome were 0.791 (0.470–1.332; p = 0.3779) in the WMH (+) ICAS (–) group, 1.920 (1.024–3.600; p = 0.0421) in the WMH (–) ICAS (+) group, and 2.046 (1.230–3.403; p = 0.0058) in the WMH (+) ICAS (+) group. There was no significant difference in stroke recurrence risk among the four groups.Conclusion: ICAS coexisting with WMH may predict an unfavorable functional outcome at 1 year, but not stroke recurrence.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intracranial Atherosclerosis Coexisting With White Matter Hyperintensities May Predict Unfavorable Functional Outcome in Patients With Acute Cerebral Ischemia

Liu

Wang

et al. 2020

Front. Neurol.

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“…The presence of ICAD has been associated with an increased risk of recurrent stroke and disability following minor stroke and TIA [7][8][9]. Antiplatelet therapy, risk factor modification and lifestyle changes are the current standard of care for symptomatic ICAD [10].…”

Section: Discussionmentioning

confidence: 99%

MRA-detected intracranial atherosclerotic disease in patients with TIA and minor stroke

et al. 2022

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Objectives Patients with TIA and minor stroke commonly undergo CT and CTA in the emergency department with subsequent MRI with MRA for further workup. The purpose of this study was to review outpatient MRIs for TIA/stroke patients to assess the additional benefit, if any, of the MRA sequence in the detection of intracranial atherosclerotic disease in patients for whom CTA had already been performed. Methods The radiology reports of outpatient MRIs of the brain for TIA/minor stroke patients were retrospectively reviewed via the hospital PACS system. Following this, the imaging report from the patient’s initial presentation to the emergency department was reviewed. This index imaging and subsequent MRI were compared to assess the incidence of new vascular findings detected on the MRA sequence in patients for whom CTA had already been performed. Where new lesions had been identified at follow-up, the imaging was retroactively reviewed to assess if they were present on the index imaging. Results Two hundred seven consecutive patients were reviewed. Significant (> 50%) intracranial atherosclerotic disease was present on MRA in 18 patients (8.7%). This was a new finding in 11 patients. Five had initial CTA where the atherosclerosis was not detected. All 5 of these cases were located in the posterior cerebral arteries. Incidental aneurysms were seen in 14 (6.7%); 12 were a new finding at time of MRI. Conclusion The MRA sequence provides additional value by increasing the detection of clinically important intracranial atherosclerotic disease which may inform management in patients with minor stroke and TIA.

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“…Intracranial arterial stenosis was demonstrated to be associated with an increased risk of stroke and disability in minor stroke [ 10 ]. The infarct progression in patients with severe stenosis/occlusion of large vessels is one of the main causes of neurological deterioration in AIS patients [ 11 ], while a considerable number of these patients initially present mild symptoms.…”

Section: Introductionmentioning

confidence: 99%

Minor Non-Disabling Stroke Patients with Large Vessel Severe Stenosis or Occlusion Might Benefit from Thrombolysis

et al. 2021

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Background: The benefit of alteplase in minor non-disabling acute ischemic stroke (AIS) is unknown. We aimed to explore the clinical efficacy of alteplase-treatment in minor non-disabling stroke in clinical practice. Methods: We used a prospectively collected database of AIS patients who were being assessed for thrombolysis with alteplase. Minor non-disabling AIS was identified as patients with baseline National Institutes of Health Stroke Scale (NIHSS) score ≤ 5 and a score 0 or 1 on each baseline NIHSS score item (items 1a to 1c being 0). Results: A total of 461 patients with minor non-disabling AIS were included and among them 240 (52.1%) patients were treated with alteplase and 113 (24.5%) patients had severe stenosis/occlusion of large vessels. No significant association of 90-day excellent outcome was found with alteplase-treatment (77.1% vs. 80.5%, p 1 = 0.425; OR 0.911, 95% CI 0.428 to 1.940; p 2 = 0.808). However, among patients with severe stenosis/occlusion of large vessels, alteplase-treatment was independently associated with excellent outcome (74.4% vs. 45.7%, p 1 = 0.005; OR 4.709, 95% CI 1.391 to 11.962; p 2 = 0.010). Conclusion: Although alteplase-treatment did not result in an excellent outcome in general minor non-disabling stroke patients, it may work in those specific patients who had severe stenosis/occlusion of large vessels.

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Cerebral small vessel disease or intracranial large vessel atherosclerosis may carry different risk for future strokes

Cited by 28 publications

References 26 publications

Intracranial Atherosclerosis Coexisting With White Matter Hyperintensities May Predict Unfavorable Functional Outcome in Patients With Acute Cerebral Ischemia

Intracranial Atherosclerosis Coexisting With White Matter Hyperintensities May Predict Unfavorable Functional Outcome in Patients With Acute Cerebral Ischemia

MRA-detected intracranial atherosclerotic disease in patients with TIA and minor stroke

Minor Non-Disabling Stroke Patients with Large Vessel Severe Stenosis or Occlusion Might Benefit from Thrombolysis

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