Correlation between total burden of cerebral small vessel disease and outcomes in large artery atherosclerotic stroke

Abstract

Objective To investigate the relationship between the total burden of cerebral small vessel disease (CSVD) and the outcomes in patients with large artery atherosclerotic (LAA) stroke. Methods From June 2016 to January 2018, patients with LAA stroke treated at the Department of Neurology, the Affiliated Hospital of Qingdao University were enrolled retrospectively. The overall burden of CSVD was evaluated according to MRI findings. The National Institute of Health Stroke Scale (NIHSS) was used to evaluate the severity of stroke. The modified Rankin scale (mRS) was used to evaluate the outcomes at day 90 after the onset. The mRS score 0-2 was defined as good outcome, and >2 was defined as poor outcome. Results A total of 148 patients with LAA stroke were enrolled, including good outcome in 72 (48.65%) and poor outcome in 76 (51.35%). There were significant differences in the proportions of hypertension (69.44% vs. 85.52%; χ2=5.519, P=0.019), taking antihypertensive drugs before the onset (48.61% vs. 69.74%; χ2=6.845, P=0.009), white matter hyperintensity (18.06% vs. 39.47%; χ2=8.228, P=0.004), enlarged perivascular space (33.33% vs. 60.53%; χ2=10.968, P=0.001), as well as the baseline NIHSS scores (3.00 [2.00-4.00] vs. 7.0 [5.0-10.0]; Z=-8.159, P=0.001), baseline systolic blood pressure (149.40±15.80 mmHg vs. 157.21±14.05 mmHg; t=3.180, P=0.002; 1 mmHg=0.133 kPa), fasting glucose (5.91±2.06 mmol/L vs. 6.92±2.65 mmol/L; t=2.595, P=0.010), and the proportions of total CSVD scores 0, 1, 2, 3, and 4 (Z=-4.927, P=0.001)between the 2 groups. After adjustment for the confounding factors, such as hypertension and fasting glucose, multivariate regression analysis showed that the total CSVD score (odds ratio 4.457, 95% confidence interval 1.768-11.236; P=0.002) and baseline NIHSS score (odds ratio 2.070, 95% confidence interval 1.580-2.710; P<0.001) were the independent risk factors for the poor outcomes in patients with LAA stroke. Conclusions The total CSVD burden was closely associated with the outcomes in patients with LAA stroke. Higher CSVD total score and baseline NIHSS scores were independently associated with the poor outcome at 90 d in patients with LAA stroke. Key words: Stroke; Brain Ischemia; Cerebral Small Vessel Diseases; Magnetic Resonance Imaging; Atherosclerosis; Treatment Outcome; Risk Factors