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. 2024 Aug;271(8):5055-5063.
doi: 10.1007/s00415-024-12460-8. Epub 2024 May 27.

Recurrent cerebrovascular events after recent small subcortical infarction

Melanie Haidegger  1 , Nina Klock  1 , Markus Kneihsl  1   2 , Simon Fandler-Höfler  1 , Sebastian Eppinger  1   2 , Kathrin Eller  3 , Stephan Seiler  1 , Christian Enzinger  1 , Thomas Gattringer  4   5
Affiliations

Recurrent cerebrovascular events after recent small subcortical infarction

Melanie Haidegger et al. J Neurol. 2024 Aug.

Abstract

Background: Recent small subcortical infarcts (RSSI) are the neuroimaging hallmark feature of small vessel disease (SVD)-related acute lacunar stroke. Long-term data on recurrent cerebrovascular events including their aetiology after RSSI are scarce.

Patients and methods: This retrospective study included all consecutive ischaemic stroke patients with an MRI-confirmed RSSI (in the supply area of a small single brain artery) at University Hospital Graz between 2008 and 2013. We investigated associations between clinical and SVD features on MRI (STRIVE criteria) and recurrent cerebrovascular events, using multivariable Cox regression adjusted for age, sex, vascular risk factors and MRI parameters.

Results: We analysed 332 consecutive patients (mean age 68 years, 36% women; median follow-up time 12 years). A recurrent ischaemic cerebrovascular event occurred in 70 patients (21.1%; 54 ischaemic strokes, 22 transient ischaemic attacks) and was mainly attributed to SVD (68%). 26 patients (7.8%) developed intracranial haemorrhage. In multivariable analysis, diabetes (HR 2.43, 95% CI 1.44-3.88), severe white matter hyperintensities (HR 1.97, 95% CI 1.14-3.41), and cerebral microbleeds (HR 1.89, 95% CI 1.32-3.14) on baseline MRI were related to recurrent ischaemic stroke/TIA, while presence of cerebral microbleeds increased the risk for intracranial haemorrhage (HR 3.25, 95% CI 1.39-7.59). A widely used SVD summary score indicated high risks of recurrent ischaemic (HR 1.22, 95% CI 1.01-1.49) and haemorrhagic cerebrovascular events (HR 1.57, 95% CI 1.11-2.22).

Conclusion: Patients with RSSI have a substantial risk for recurrent cerebrovascular events-particularly those with coexisting chronic SVD features. Recurrent events are mainly related to SVD again.

Keywords: Cerebral small vessel disease; Imaging; Intracranial haemorrhage; Recent small subcortical infarct; Recurrent events.

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Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

Fig. 1
Fig. 1
Patient selection and rate of recurrent cerebrovascular events
See this image and copyright information in PMC

References

    1. Wardlaw JM, Smith C, Dichgans M (2019) Small vessel disease: mechanisms and clinical implications. Lancet Neurol 18(7):684–696 10.1016/S1474-4422(19)30079-1 - DOI - PubMed
    1. Hakim AM (2019) Small Vessel Disease. Front Neurol 10:1020 10.3389/fneur.2019.01020 - DOI - PMC - PubMed
    1. Cannistraro RJ, Badi M, Eidelman BH, Dickson DW, Middlebrooks EH, Meschia JF (2019) CNS small vessel disease: A clinical review. Neurology 92(24):1146–1156 10.1212/WNL.0000000000007654 - DOI - PMC - PubMed
    1. Chen X, Wang J, Shan Y, Cai W, Liu S, Hu M et al (2019) Cerebral small vessel disease: neuroimaging markers and clinical implication. J Neurol 266(10):2347–2362 10.1007/s00415-018-9077-3 - DOI - PubMed
    1. Makin SD, Turpin S, Dennis MS, Wardlaw JM (2013) Cognitive impairment after lacunar stroke: systematic review and meta-analysis of incidence, prevalence and comparison with other stroke subtypes. J Neurol Neurosurg Psychiatry 84(8):893–900 10.1136/jnnp-2012-303645 - DOI - PMC - PubMed

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