Abstract WP85: The Association of White Matter Hyperintensity and Outcomes in Minor Stroke and Tia Patients

Abstract

Background: The presence of white matter hyperintensity (WMH) is related to poor outcomes in stroke patients. However, the short-term outcome is unknown in patients with minor stroke and TIA and WMH. Objective: We investigated the impact of WMH on 90-day outcome in patients with minor stroke and TIA. Methods: We derived data from the Clopidogrel in High-risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) trial. After excluding 45 patients with low quality images, 8 without mRS at 3 months, 1036 patients with baseline MR examinations were included in this analysis. FAZEKAS scores were recorded for each individual. The primary efficacy outcome was ischemic stroke and mRS scores at the 90-day follow-up. We assessed the associations between FAZEKAS scores and prognosis of patients using multivariable Logistic regression models. Results: Among the 1,036 patients included in this subgroup analysis, there were 490 (47.3%), 347 (33.5%), and 199 (19.2%) patients identified as score 0-2, 3-4, 5-6, respectively. Compared with those with FAZEKAS 0-2, patients with FAZEKAS 3-4 (13.0% vs 7.6%, OR 1.53, 95% CI 0.93-2.50, p=0.093) and FAZEKAS 5-6 (11.1% vs 7.6%, OR 0.936, 95% CI 0.501-1.748, p=0.835) were not associated with higher mRS scores (2-6) at 90 days; neither did they have an increased risk of ischemic stroke (9.5% vs 8.0%, OR 1.08, 95% CI 0.64-1.81, p=0.779; 7.0% vs 8.0%, OR 0.67, 95% CI 0.33-1.35, p=0.261). However, in subgroup analysis for NIHSS 2-3, compared with FAZEKAS 5-6, FAZEKAS 3-4 was a risk factor for ischemic stroke (OR, 2.29; 95%CI 1.01-5.18; p=0.047) and higher mRS scores (OR, 1.98; 95%CI 1.03-3.82; p=0.041). Conclusion: In patients with minor stroke or TIA, Fazekas score was not associated with an increased risk of 90-day ischemic stroke and higher mRS scores. Medium grade WMH might indicate progression of cerebral small vessel disease (CSVD), while severe white matter lesion suggests relatively stabilized condition of CSVD.