Population-Based Magnetic Resonance Imaging: Earlier Detection of Hypertensive Cerebral Small Vessel Disease?

Kaul, Malvika; Rubinstein, Israel

doi:10.1161/hypertensionaha.121.17606

Cited by 2 publications

(3 citation statements)

References 10 publications

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“…In this present study, the subgroup analysis has indicated no discrepancy in the distribution of hematoma locations. Since SAHE occurs much more frequently in lobar ICH rather than deep ICH (25.8% vs. 8.2% in our study), the results may also provide more about deep ICH, such as severer conditions and higher hypertensive small vessel disease burdens [ 28 – 30 ].…”

Section: Discussionmentioning

confidence: 83%

Subarachnoid extension and unfavorable outcomes in patients with supratentorial intracerebral hemorrhage

Wang

Bian

et al. 2023

BMC Neurol

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Objective Our study aimed to investigate the association between the subarachnoid extension of intracranial hemorrhage (SAHE) and clinical outcomes in patients with supratentorial intracerebral hemorrhage (ICH). Methods We analyzed the data from a prospective, multi-center, and registry-based database. Two experienced investigators independently assessed ICH imaging data. We compared baseline characteristics and follow-up outcomes. Multivariable logistic regression analysis was used to evaluate the association between SAHE and poor clinical outcomes. We also performed Kaplan–Meier curves and Cox proportional hazards regression analyses to analyze whether SAHE was relevant to a higher mortality rate. Results A total of 931 patients were included in this study (SAHE vs. no SAHE, 121 [13.0%] vs. 810 [87.0%]). Patients with SAHE had more severe neurological deficits, higher scores of the mRS, and more remarkable mortality rates at follow-up (all p values < 0.05). In multivariable-adjusted models, SAHE was independently associated with a higher risk of poor outcomes (adjusted OR [95%CI]: 2.030 [1.142–3.608] at 3 months; 2.348 [1.337–4.123] at 1 year). In addition, SAHE remained an independent association with an increased death rate at 1 year (adjusted HR [95%CI], 1.314[1.057–1.635]). In the subgroup analysis, the correlation between SAHE and prognosis exists in patients with lobar or deep ICH. Conclusions SAHE is independently associated with poor outcomes in patients with supratentorial ICH. It may provide a promising target for developing new predictive tools targeting ICH.

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Section: Discussionmentioning

confidence: 83%

Subarachnoid extension and unfavorable outcomes in patients with supratentorial intracerebral hemorrhage

Wang

Bian

et al. 2023

BMC Neurol

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“…This potentially results in lower cognitive function when blood pressure (BP) control is poor or lacking (Litak et al, 2020). For instance, increased pulse and mean arterial pressure are conducive to forming an ischemic environment in the cerebral white matter by disrupting autoregulation and induction of endothelial cell senescence and cell death in small vessels (Kaul and Rubinstein, 2021). The above changes trigger BBB dysfunction, additional vascular permeability upregulation, and activation of pro-inflammatory mediators in localized effector cells, eventually causing substantial damage and WMH on brain MRI (Kaul and Rubinstein, 2021).…”

Section: Introductionmentioning

confidence: 99%

“…For instance, increased pulse and mean arterial pressure are conducive to forming an ischemic environment in the cerebral white matter by disrupting autoregulation and induction of endothelial cell senescence and cell death in small vessels (Kaul and Rubinstein, 2021). The above changes trigger BBB dysfunction, additional vascular permeability upregulation, and activation of pro-inflammatory mediators in localized effector cells, eventually causing substantial damage and WMH on brain MRI (Kaul and Rubinstein, 2021). Angiotensin II (Ang II) is a vasoactive peptide of the renin-angiotensin system (RAS) and an essential molecular signal in HT.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of naotaifang capsules for hypertensive cerebral small vessel disease: Study protocol for a multicenter, randomized, double-blind, placebo-controlled clinical trial

Fang

Zhou

et al. 2023

Front. Pharmacol.

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Background: Hypertensive cerebral small vessel disease (HT-CSVD) is a cerebrovascular clinical, imaging and pathological syndrome caused by hypertension (HT). The condition manifests with lesions in various vessels including intracranial small/arterioles, capillaries, and small/venules. Hypertensive cerebral small vessel disease has complex and diverse clinical manifestations. For instance, it can present as an acute stroke which progresses to cause cognitive decline, affective disorder, unstable gait, dysphagia, or abnormal urination. Moreover, hypertensive cerebral small vessel disease causes 25–30% of all cases of ischemic strokes and more than 50% of all cases of single or mixed dementias. The 1-year recurrence rate of stroke in cerebral small vessel disease patients with hypertension is 14%. In the early stage of development, the symptoms of hypertensive cerebral small vessel disease are concealed and often ignored by patients and even clinicians. Patients with an advanced hypertensive cerebral small vessel disease manifest with severe physical and mental dysfunction. Therefore, this condition has a substantial economic burden on affected families and society. Naotaifang (NTF) is potentially effective in improving microcirculation and neurofunction in patients with ischemic stroke. In this regard, this multicenter randomized controlled trial (RCT) aims to furtherly evaluate the efficacy and safety of naotaifang capsules on hypertensive cerebral small vessel disease.Methods: This study is a multicenter, randomized, double-blind, placebo-controlled clinical trial. A total of 388 eligible subjects were recruited from the First Hospital of Hunan University of Chinese Medicine, Hunan Academy of Chinese Medicine Affiliated Hospital, the First Hospital of Shaoyang University, the First Traditional Chinese Medicine Hospital of Changde, and Jiangmen Wuyi Hospital of Traditional Chinese Medicine from July 2020 to April 2022. After a 4-week run-in period, all participants were divided into the intervention group (represented by Y-T, N-T) and control group (represented by Y-C, N-C); using a stratified block randomized method based on the presence or absence of brain damage symptoms in hypertensive cerebral small vessel disease (represented by Y and N). The Y-T and N-T groups were administered different doses of naotaifang capsules, whereas Y-C and N-C groups received placebo treatment. These four groups received the treatments for 6 months. The primary outcome included Fazekas scores and dilated Virchow-robin spaces (dVRS) grades on magnetic resonance imaging (MRI). The secondary outcomes included the number of lacunar infarctions (LI) and cerebral microbleeds (CMB) on magnetic resonance imaging, clinical blood pressure (BP) level, traditional Chinese medicine (TCM) syndrome scores, mini-mental state examination (MMSE) scale, and safety outcomes. Fazekas scores, dilated Virchow-robin spaces grades, and the number of lacunar infarctions and cerebral microbleeds on magnetic resonance imaging were tested before enrollment and after 6 months of treatment. The clinical blood pressure level, traditional Chinese medicine syndrome scores, mini-mental state examination scale and safety outcomes were tested before enrollment, after 3-month, 6-month treatment and 12th-month follow-up respectively.Conclusion: The protocol will comfirm whether naotaifang capsules reduce Fazekas scores, dilated Virchow-robin spaces grades, and the number of lacunar infarctions and cerebral microbleeds, clinical blood pressure, increase mini-mental state examination scores, traditional Chinese medicine syndrome scores of Qi deficiency and blood stasis (QDBS), and improve the quality of life of subjects. The consolidated evidence from this study will shed light on the benefits of Chinese herbs for hypertensive cerebral small vessel disease, such as nourishing qi, promoting blood circulation and removing blood stasis, and dredging collaterals. However, additional clinical trials with large samples and long intervention periods will be required for in-depth research.Clinical Trial registration:www.chictr.org.cn, identifier ChiCTR1900024524.

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Population-Based Magnetic Resonance Imaging: Earlier Detection of Hypertensive Cerebral Small Vessel Disease?

Cited by 2 publications

References 10 publications

Subarachnoid extension and unfavorable outcomes in patients with supratentorial intracerebral hemorrhage

Subarachnoid extension and unfavorable outcomes in patients with supratentorial intracerebral hemorrhage

Efficacy and safety of naotaifang capsules for hypertensive cerebral small vessel disease: Study protocol for a multicenter, randomized, double-blind, placebo-controlled clinical trial

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