Abstract TP260: Association Between Cerebral Small Vessel Disease and Prehospital Delay in Acute Ischemic Stroke

Abstract

Objective: To elucidate whether the severity of cerebral small vessel disease (SVD) is associated with the prehospital delay in acute ischemic stroke. Methods: Consecutive ischemic stroke patients admitted to our hospital were screened. Inclusion criterion was: onset to door time within 14 days. Exclusion criteria were: in-hospital onset stroke, and patients without an MRI scan. We evaluated SVD burden using the total SVD score defined as a sum of the following four items (maximum score 4): old lacunes, cerebral microbleeds, basal ganglia enlarged perivascular spaces (EPVS), and white matter hyperintensity. EPVS severity was classified as follows; grade 0 = no EPVS, grade 1 = 1-10 EPVS, grade 2 = 11-20 EPVS, grade 3 = 21-40 EPVS, and grade 4 = 41 or more EPVS. Patients were divided into two groups, onset to door time within 4.5 hours (early arrival group) and over 4.5 hours (delayed arrival group). First, we assessed whether the total SVD score could be related to the two groups using logistic regression analysis. Second, we assessed which item of the total SVD score was independently associated with the prehospital delay. Finally, we checked if that item had a linear association with the prehospital delay. Results: We screened 2,112 patients, including 1,754 (1,253 (71%) male, median age 69 years). Of all, 1,105 patients (63%) were included in the delayed arrival group. The total SVD score was independently associated with the prehospital delay (OR 1.11, 95% CI 1.01-1.21, p =0.025). Among the four items, only EPVS was independently associated with the prehospital delay (OR 1.37, 95% CI 1.05-1.80, p =0.022). A linear trend was observed between EPVS grades and the prehospital delay in reference to EPVS grade 0-1 (EPVS grade 2: OR 1.22, 95% CI 0.92-1.62, p = 0.170, EPVS grade 3: OR 1.69, 95% CI 1.20-2.38, p = 0.002, EPVS grade 4: OR 2.17, 95% CI 1.37-3.44, p = 0.001, Figure). Conclusions: Prehospital delay in acute ischemic stroke could be associated with SVD, especially basal ganglia EPVS.