Abstract
Perivascular spaces (PVSs) are considered markers of small vessel disease. However, their long-term prognostic implications in transient ischemic attack/ischemic stroke patients are unknown. Ethnic differences in PVS prevalence are also unknown. Two independent prospective studies were conducted, 1 comprising predominantly whites with transient ischemic attack/ischemic stroke (OXVASC [Oxford Vascular] study) and 1 comprising predominantly Chinese with ischemic stroke (University of Hong Kong). Clinical and imaging correlates, prognostic implications for stroke and death, and ethnic differences in basal ganglia (BG) and centrum semiovale (CS) PVSs were studied with adjustment for age, sex, vascular risk factors, and scanner strength. Whites with transient ischemic attack/ischemic stroke (n=1028) had a higher prevalence of both BG and CS-PVSs compared with Chinese (n=974; >20 BG-PVSs: 22.4% versus 7.1%; >20 CS-PVSs: 45.8% versus 10.4%; P<0.0001). More than 20 BG or CS-PVSs were both associated with increasing age and white matter hyperintensity, although associations with BG-PVSs were stronger (all P<0.0001). During 6924 patient-years of follow-up, BG-PVSs were also independently associated with an increased risk of recurrent ischemic stroke (adjusted hazard ratio compared with <11 PVSs, 11-20 PVSs: HR, 1.15; 95% confidence interval, 0.78-1.68; >20 PVSs: HR, 1.82; 1.18-2.80; P=0.011) but not intracerebral hemorrhage (P=0.10) or all-cause mortality (P=0.16). CS-PVSs were not associated with recurrent stroke (P=0.57) or mortality (P=0.072). Prognostic associations were similar in both cohorts. Over and above ethnic differences in frequency of PVSs in transient ischemic attack/ischemic stroke patients, BG and CS-PVSs had similar risk factors, but although >20 BG-PVSs were associated with an increased risk of recurrent ischemic stroke, CS-PVSs were not.
Highlights
Background and PurposePerivascular spaces (PVSs) are considered markers of small vessel disease
Over and above ethnic differences in frequency of PVSs in transient ischemic attack/ischemic stroke patients, basal ganglia (BG) and centrum semiovale (CS)-PVSs had similar risk factors, but >20 BG-PVSs were associated with an increased risk of recurrent ischemic stroke, CS-PVSs were not
Perivascular spaces (PVSs) are tiny cavities of cerebrospinal fluid that surround arterioles that penetrate the brain parenchyma.[1]. They are most frequently found in the inferior basal ganglia (BG), centrum semiovale (CS), and midbrain.[2]
Summary
Two independent prospective studies were conducted, 1 comprising predominantly whites with transient ischemic attack/ischemic stroke (OXVASC [Oxford Vascular] study) and 1 comprising predominantly Chinese with ischemic stroke (University of Hong Kong). We prospectively studied patients with TIA/ischemic stroke from 2 cohorts: the OXVASC (Oxford Vascular) Study and the University of Hong Kong (HKU). OXVASC is an ongoing populationbased study of all acute vascular events occurring within a population of all 92 728 individuals, irrespective of age, who are registered with 100 general practitioners in 9 general practices of Oxfordshire, United Kingdom.[15] The analysis includes 1080 consecutive cases of TIA/ischemic stroke recruited from November 1, 2004, to September 30, 2014, who had a cerebral magnetic resonance imaging (MRI). From April 1, 2010, onward (phase 2), brain MRI and magnetic resonance angiography of intra- and extracranial vessels became the first-line imaging methods.[16] A further 1076 consecutive patients who were predominantly Chinese with a diagnosis of acute ischemic stroke who received an MRI scan and magnetic resonance angiography of the intra- and extracranial blood vessels at the HKU MRI Unit were recruited during March 1, 2008, to September 30, 2014
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