Abstract W P110: Preexisting Cerebral Small Vessel Disease Increases Cortical Infarct Volume after Distal Middle Cerebral Artery Occlusion

Abstract

Background: Cerebral small vessel disease (cSVD) predominantly affects the subcortical white matter. However, little is known about its impact on cortical ischemic susceptibility. We sought to assess whether preexisting cSVD is predictive of the cortical infarct volume following middle cerebral artery (MCA) branch occlusion and whether it relates to a worse 90-day outcome. Methods: We analyzed data from 117 consecutive patients with MCA branch occlusion as documented by admission computed tomography (CT)-angiography. To avoid potential confounding, we excluded patients with subcortical infarction. Baseline clinical, laboratory, and outcome data as well as final cortical infarct volumes on follow-up imaging were retrospectively analyzed from a prospectively collected database. Severity of cSVD was assessed on admission CT using the van Swieten scale (VSS), grading the white matter lesions on a 3-point scale from 0 (absent) to 4 (severe). We also dichotomized the degree of cSVD (VSS 0-2 [absent to moderate] vs. 3-4 [severe]) for statistical purposes. Multivariable linear and logistic regression analyses were used to identify independent predictors of the final infarct volume. Results: A final infarct volume of ≤27 mL best predicted a favorable 90-day outcome (mRS≤2) as determined by receiver operating characteristic curves. Severe cSVD (OR 7.434; 95%-CI 1.549-35.676; p=0.012) was independently associated with infarct volume >27 mL. Patients with severe cSVD had significantly larger cortical lesion volumes compared to patients without (Figure1A). Severe cSVD (OR 3.027; 95%-CI 1.013-9.048; p=0.047) and infarct volume >27 mL (OR 9.038; 95%-CI 1.997-40.899; p=0.004) were independent predictors of a poor 90-day outcome (mRS 3-6; Figure 1B). Conclusion: Severe subcortical cSVD contributes to larger cortical infarct volumes and worse functional outcome adding to the notion that the brain is negatively affected beyond cSVD ‘s macroscopic boundaries.