Abstract 66: MRI Predictors of Stroke Recurrence in Patients With Recent Lacunar Stroke: The SPS3 Trial

Abstract

Background: Brain infarcts (BIs) and white matter hyperintesities (WMHs) have been associated with an increased risk of stroke. However, neither has been investigated in a well characterized cohort of patients with cerebral small vessel disease. Our objective was to identify MRI predictors of recurrent stroke in the SPS3 cohort. Methods: SPS3 was a multicenter trial that enrolled 3020 patients with recent lacunar stroke verified by MRI. Baseline MRIs were centrally read, including presence of index infarct, old subcortical brain infarcts (also called lacunar infarcts) (BIs), and WMHs using the ARWMC score, and independent predictors of recurrent stroke identified. A stratification scheme for stroke risk was developed based on MRI findings and previously identified clinical risk factors (RF) of prior stroke/TIA, black race, male, diabetes. Results: 2980 MRIs were included in these analyses. BIs (HR 1.5, 95% CI 1.2, 1.9) and more severe WMHs (HR 1.4, CI 1.2, 1.6) were independently associated with recurrent stroke, and remained independent after including clinical RF and assigned treatments in the Cox PH model. Anatomical localization of the index stroke was not associated with stroke recurrence. Annualized recurrent stroke rates were 5.2 %/pt-yr (95% CI 4.3, 6.2), 2.7% (95% CI 2.2, 3.4), and 1.7% (95% CI 1.1, 1.7) respectively in high (> 2 of the following: prior stroke/TIA, BIs, severe WMD, or all 3 other clinical RF), moderate (not high risk; prior stroke/TIA or 2 clinical RF), and low (not moderate or high risk; 0-1 clinical RF) risk patients. Conclusions: In this large, well-characterized cohort of recent lacunar strokes, old subcortical infarcts and WMHs on MRI are shown to be independent predictors of stroke recurrence. Stratification schemes may help to identify patients at different risk and select the most appropriate therapeutic intervention for stroke reduction.