Introduction: Few studies have systematically investigated the association between periodontal disease (PD) and small vessel disease (SVD) in stroke/TIA patients. White matter hyperintensity (WMH) is a manifestation of SVD in the brain and is a surrogate for vascular cognitive impairment. Methods: Consecutive stroke/TIA patients admitted to our tertiary stroke center were assessed for PD as a part of a stroke study. PD was defined as moderate/severe periodontitis by Center for Disease Control/American Academy of Periodontology Working Group. Periventricular (PVWMH) and deep white matter (DWMH) were rated visually on axial FLAIR imaging using the 4-point Fazeka scale and were categorized into none/mild (grades 0-1) or moderate/severe (grades 2-3). Total WMHs were dichotomized into none/mild (grades 0-2) or moderate/severe (grades 3-6). Student t-tests were performed to test continuous variables, and X 2 test was used to compare categorical variables. Multivariable analysis was conducted using multiple logistic regression to test the association between PD and WMH. Results: A total of 861 consecutive patients, 404 with PD and 457 without PD, were compared for moderate/severe PVWMH and DWMH. Patients with PD were more likely to be African American (AA) compared to whites (55% vs. 36%, p<0.001). They were also more likely to be smokers (62% vs. 42%, p<0.001). Patients with PD were similar in age (63.7±12.0 vs. 63.4 ± 12.8), gender, hypertension, diabetes, hyperlipidemia, and atrial fibrillation status. PD was associated with total WMH (OR 1.51, 95% 1.14-2.00) and DWMH (OR 1.46, 95% 1.08-1.97). PD was not significantly associated with PVWMH (OR 1.30, 95% 0.98-1.73). These associations remained significant after adjusting for age, gender, race, hypertension, diabetes, and smoking for total WMH (Adj. OR 1.38, 95% 1.01-1.88) and DWMH (Adj. OR 1.37, 95% 1.00-1.90) and remained nonsignificant for PVWMH (Adj. OR 1.24, 95% 0.91-1.70). Conclusion: Stroke/TIA patients with PD were more likely to be AA and smokers. We report significant independent associations of PD with total WMH and DWMH manifestations of SVD. This suggests that stroke risk in AA and smokers may be partly mediated by SVD.
Introduction: Hypoperfusion index ratio (HIR) measured by computerized tomography perfusion (CTP) has been shown to predict collateral flow state in acute ischemic stroke (AIS). Low HIR (<0.4) is indicative of good collateral flow state. Hypothesis: Good collateral flow state correlates with lower stroke severity and better clinical outcome at discharge. Methods: Data from AIS patients who underwent CTP during initial stroke evaluation were linked with Get With the Guideline database in a comprehensive stroke center between 2018 and 2020. Patients with good collateral flow (HIR<0.4) were compared to those with poor collateral flow (≥0.4) group. They were stratified based on modified Rankin Score (mRS) at discharge into good outcome (mRS 0-2) or poor outcome (mRS 3-6). In addition to demographics, and risk factors data was collected on the initial stroke severity using the NIH stroke scale (NIHSS). Continuous variables were compared using t-test (parametric) and Mann-Whitney U test (non-parametric). Univariate and multivariable analyses (multiple logistic regression) were used to test the association between good collateral flow state and good discharge outcome. Results: CT perfusion data was obtained in 1442 patients, after excluding patients who underwent thrombectomy and all non-vascular etiologies of stroke like presentation, there was 890 patients (age 68±14, 52% male, 50% white, 50% black/others), of who 756 (85%) demonstrated good collateral flow and 134 (15%) showed poor collateral flow. Those with good collateral flow were younger (68±14 vs. 70±15, p=0.07) and lower median NIHSS (6 IQR 3-10 vs. 13 IQR 6-18, p<0.001). Good collateral flow was associated with good outcome on discharge (OR 2.2, 95% CI 1.5-3.3). The association remained significant after adjustment for age, gender, race, hypertension, diabetes, coronary artery disease, congestive heart failure and atrial fibrillation (adjusted OR 2.2 (1.4-3.3). Conclusions: In patients presenting with AIS, good collateral flow state was associated with lower stroke severity. It was independently associated with good outcome after adjustment for several comorbidities. Based on our study results, CT perfusion imaging may have utility in predicting stroke severity and discharge outcome.
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