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. 2017 Oct 9;12(10):e0184944.
doi: 10.1371/journal.pone.0184944. eCollection 2017.

The presence and severity of cerebral small vessel disease increases the frequency of stroke in a cohort of patients with large artery occlusive disease

Ki-Woong Nam  1   2 , Hyung-Min Kwon  1   2 , Jae-Sung Lim  1   3 , Moon-Ku Han  4 , Hyunwoo Nam  1   2 , Yong-Seok Lee  1   2
Affiliations

The presence and severity of cerebral small vessel disease increases the frequency of stroke in a cohort of patients with large artery occlusive disease

Ki-Woong Nam et al. PLoS One. .

Abstract

Background: Cerebral small vessel disease (SVD) commonly coexists with large artery atherosclerosis (LAA).

Aim: We evaluate the effect of SVD on stroke recurrence in patients for ischemic stroke with LAA.

Methods: We consecutively collected first-ever ischemic stroke patients who were classified as LAA mechanism between Jan 2010 and Dec 2013. Univariate and multivariate Cox analyses were performed to evaluate the association between the 2-year recurrence and demographic, clinical, and radiological factors. To evaluate the impact of SVD and its components on recurrent stroke, we used the Kaplan-Meier analysis. SVD was defined as the presence of severe white matter hyperintensity (WMH) or old lacunar infarction (OLI) or cerebral microbleeds (CMB). We also compared frequency and burden of SVD among recurrent stroke groups with different mechanisms.

Results: Among a total of 956 participants, 92 patients had recurrent events. Recurrence group showed a higher frequency of severe WMH, OLI, asymptomatic territorial infarction, and severe stenosis on the relevant vessel in multivariate analysis. The impact of SVD and its components on recurrent stroke was significant in any ischemic recurrent stroke, and the presence of SVD was continuously important in stroke recurrence regardless of its mechanism, including recurrent LAA stroke, recurrent small vessel occlusion stroke, and even recurrent cardioembolic stroke. Additionally, the recurrence rate increased in dose-response manner with the increased number of SVD components.

Conclusions: Cerebral SVD is associated with recurrent stroke in patients with LAA. Additionally, it may affect any mechanisms of recurrent stroke and even with a dose response manner.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Patient selection flow chart.
Fig 2
Fig 2. Recurrent stroke between with and without SVD, severe WMH, OLI, or CMB.
Recurrent stroke rate was significantly higher in the group with small vessel disease (A) (P < 0.001), severe white matter hyperintensity (B) (P < 0.001), old lacunar infarction (C) (P < 0.001), or cerebral microbleeds (D) (P < 0.001).
Fig 3
Fig 3. Recurrent stroke with the number of components of small vessel disease.
Number of components of small vessel disease showed a dose-response manner with 2-year recurrent stroke both in the Kaplan-Meier analysis (P < 0.001) (A) and univariate Cox regression analysis adjusted by survival time (P < 0.001) (B).
Fig 4
Fig 4. Effect of small vessel disease on stroke recurrence in different recurrence mechanisms.
Patients with small vessel disease had higher chances of recurrent large artery atherosclerosis stroke (A) (P < 0.001), recurrent large artery atherosclerosis stroke in the same territory of the index stroke (B) (P = 0.003), recurrent cardioembolism stroke (C) (P = 0.033), and recurrent small vessel occlusion stroke (D) (P = 0.002). Small vessel disease could be a risk factor of recurrent stroke without considering its recurrence mechanisms.
See this image and copyright information in PMC

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