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. 2017 Jul 17;17(1):135.
doi: 10.1186/s12883-017-0918-y.

Greater periventricular white matter hyperintensity severity in basilar artery branch atheromatous disease

Po-Chen Lin  1   2 , Feng-Chi Chang  2   3 , Hui-Chi Huang  1   4 , Jui-Yao Tsai  1   4 , Yung-Yang Lin  1   2 , Chih-Ping Chung  5   6
Affiliations

Greater periventricular white matter hyperintensity severity in basilar artery branch atheromatous disease

Po-Chen Lin et al. BMC Neurol. .

Abstract

Background: Basilar artery branch atheromatous disease (BABAD), in which basilar artery atheroma occludes penetrating arteries at their origin, is a common etiology of posterior circulation stroke (PCS). It is currently unknown whether white matter hyperintensity(WMH), a marker of small vessel disease(SVD), is associated with BABAD.

Methods: The present study analyzed data from patients with PCS who were enrolled in the Taipei Veterans General Hospital Stroke Registry between January 1, 2010 and February 28, 2014. WMH severity was rated using the Scheltens scale. We used multivariate analyses to: (1) compare the severity of WMH between patients with BABAD, patients with large-artery > 50% atherosclerotic stenosis-related PCS(LAA), and non-stroke subjects(NS); and (2) evaluate the relationship between WMH severity and the 3-month prognosis of patients with BABAD.

Results: The study pool included 151 BABAD, 97 LAA, and 78 non-stroke patients. Multivariate analyses adjusting for age, sex, and vascular risk factors showed that compared to patients with LAA [Odds ratio(OR) = 0.51, p = 0.037] and NS (OR = 0.40, p = 0.004), patients with BABAD (OR = 1) had greater WMH severity (score ≥ 50th percentile) in periventricular, but not subcortical, regions. Moreover, greater periventricular WMH severity predicted poor 3-month functional outcomes (modified Rankin Scale > 3) with an OR of 3.21 (p = 0.028) in BABAD patients.

Conclusions: We are the first to show a significant association between WMH and BABAD that is independent of vascular risk factors and atherosclerotic large-artery disease. Our results suggest that small vessel abnormalities other than lipohyalinosis may be involved in BABAD pathophysiology. A future management strategy should include both large and small vessel protection.

Keywords: Basilar artery; Branch atheromatous disease; Posterior circulation ischemic stroke; White matter hyperintensity.

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Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the institutional review board (IRB) at Taipei Veterans General Hospital, Taiwan (IRB number: 2016–04-002CC).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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