Abstract TP512: White Matter Lesion Volume Change and Antiplatelet Treatment in Small Vessel Disease; Quantitative Analysis From Picasso Study

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Background: White matter lesion (WML) is associated with future stroke risk and cognitive decline. Though antiplatelet treatment strategy is important in the prevention of secondary stroke, the effect on WML volume change is not clarified yet. Methods: This study was performed by a post-hoc analysis of PICASSO study which compared the efficacy and safety of cilostazol versus aspirin in patients with small vessel disease. Among those who have a follow-up imaging data, change of WML volume was measured quantitatively and automatically. Segmented lesion maps of different time points were compared using the longitudinal pipeline. The absolute difference was compared between aspirin and cilostazol. Factors associated with the change of WML volume were analyzed. Result: Among those enrolled in PICASSO trial, 505 patients (254 in aspirin group and 251 in cilostazol group) was measured. WML volume decreased 0.5±11.6cc at follow-up. There was no difference in WML change between cilostazol and aspirin (-0.7±12.5cc vs. -0.2±10.6; p=0.60). Old age (r=0.12, p=0.006), diabetes (p=0.03) and longer follow-up period (r=0.11; p=0.012) was associated with increase of WML. Interestingly, the presence of diabetes was associated with increased WML in aspirin group (2.4±10.3cc vs. -1.5±10.6cc; p=0.006), but not in cilostazol group (-0.3±15.0cc vs, -0.9±11.4cc; p=0.7; p for interaction=0.15). Furthermore, WML increased in aspirin group significantly with low initial systolic blood pressure (r=0.20, p=0.02), but not in cilostazol group (p=0.75; p for interaction=0.01). Conclusion: Though there is no significant difference in WML change between cilostazol and aspirin treatment, factors associated with WML change may differ according to antiplatelet treatment.