Abstract WP560: Cerebral Small Vessel Disease is Associated With Poor Collateral Recruitment in Large-Vessel Occlusive Stroke

Abstract

Introduction: Cerebral small-vessel disease (SVD) is associated with increased stroke risk and poor stroke outcomes. We aimed to evaluate if chronic SVD burden is associated with poor recruitment of collaterals in large-vessel occlusive stroke. Methods: Consecutive patients with MCA±ICA occlusion presenting within 6 hours after stroke symptoms onset from 2012- 2016 were included. Primary outcome was collateral flow, which was assessed on baseline CT-angiogram (poor ≤50% filling, good >50% filling). Markers of chronic SVD on brain MRI were rated for the presence of WMH (Fazekas scale 2-3), enlarged perivascular spaces (EPVS), chronic lacunae, and any cerebral microbleeds (CMB) using the STRIVE criteria. Severity of SVD was quantified by adding the presence of each SVD feature to a maximum score of 4. Multivariable logistic regression models were performed to evaluate the relationships between SVD and poor collaterals. Results: Of the 100 patients, the mean age was 65±16, median NIHSS was 15, and 68% had SVD. Poor collaterals were observed in 46%, and those with SVD were more likely to have poor collaterals (aOR 1.9; 95%CI 1.1-3.2) than patients without SVD. Of the SVD types, poor collaterals were associated with WMH (aOR 2.9 per Fazekas increment; 95%CI 1.6-5.3) but not EPVS (aOR 1.3; 0.4-4.0), lacunae (aOR 2.1; 0.6-7.1), or CMB (aOR 2.1; 0.6-7.8). Having a greater number of different SVD markers was associated with a higher odds of poor collaterals (crude trend p<.001; adjusted p=.056). There was a dose-dependent relationship between WMH burden and poor collaterals: adjusted odds of poor collaterals were 1.5, 3.0, and 9.7 across Fazekas scores of 1-3 (trends P=.015, Table). No patient with SVD score of 4 had good collaterals. Conclusions: Chronic cerebral small-vessel disease is associated with poor recruitment of collaterals in large-vessel occlusive stroke. A prospective study to elucidate the mechanism of how SVD may impair the recruitment of collaterals is ongoing.