Total small vessel disease score and risk of recurrent stroke

Lau, Kui Kai; Li, Linxin; Schulz, Ursula G.; Simoni, Michela; Chan, Koon Ho; Ho, Shu Leong; Cheung, Raymond Tak Fai; Küker, Wilhelm; Mak, Henry Ka‐Fung; Rothwell, Peter M.

doi:10.1212/wnl.0000000000004042

Cited by 167 publications

(227 citation statements)

References 25 publications

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“…Recently, Lau et al . considered some refinements to the previous approach, incorporating the burden of CMBs and WMHs and adjusting the cutoff of BG‐EPVSs (>20) . The new cSVD score improved the predictive power for ICH but not recurrent ischaemic stroke.…”

Section: Discussionmentioning

confidence: 99%

“…Besides, this research demonstrated an independent association between high-grade total cSVD score and the presence of R-DWILs, as well as an accumulation of total cSVD burden with increasing number of R-DWILs, further highlighting the role of cSVD in the aetiology of R-DWILs. Recently, Lau et al considered some refinements to the previous approach, incorporating the burden of CMBs and WMHs and adjusting the cutoff of BG-EPVSs (>20) [16]. The new cSVD score improved the predictive power for ICH but not recurrent ischaemic stroke.…”

Section: Besides a Close Relationship Between Lacunes And R-mentioning

confidence: 99%

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Association between remote diffusion‐weighted imaging lesions and cerebral small vessel disease in primary intracerebral hemorrhage

et al. 2019

Euro J of Neurology

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Background and purpose The aim of this study was to examine the association amongst remote diffusion‐weighted imaging lesions (R‐DWILs), imaging markers of cerebral small vessel disease (cSVD) and total cSVD burden in patients with primary intracerebral haemorrhage (ICH). Methods In total, 344 consecutive primary ICH patients were enrolled prospectively. R‐DWILs on magnetic resonance imaging as well as four imaging markers of cSVD, including cerebral microbleeds (CMBs), white matter hyperintensities (WMHs), lacunes and enlarged perivascular spaces, were rated with validated scales. The total cSVD score was calculated by adding up these four markers. Univariate and multivariate analyses were performed. Results Remote DWI lesions were detected in 57 (16.6%) primary ICH patients. On multivariate logistic regression analysis, the presence of CMBs [odds ratio (OR) 5.26, 95% confidence interval (CI) 1.72–16.12], of high‐grade WMHs (OR 4.68, 95% CI 2.01–10.90), the presence of lacunes (OR 2.69, 95% CI 1.20–6.06), mixed CMBs (OR 2.93, 95% CI 1.35–6.36), mixed lacunes (OR 3.60, 95% CI 1.25–10.37), periventricular WMHs (OR 2.19, 95% CI 1.40–3.44), deep WMHs (OR 1.92, 95% CI 1.24–2.97) and total WMHs (OR 1.52, 95% CI 1.20–1.94) were associated with the presence of R‐DWILs. A significant association was also found between high‐grade total cSVD score and R‐DWILs (OR 1.97, 95% CI 1.36–2.84). This association remained significant in patients stratified by an age of 60 years or more than 60 years. Conclusions Remote DWI lesions are correlated with the severity of each imaging marker of cSVD and with the total burden of cSVD.

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Section: Discussionmentioning

confidence: 99%

Section: Besides a Close Relationship Between Lacunes And R-mentioning

confidence: 99%

Association between remote diffusion‐weighted imaging lesions and cerebral small vessel disease in primary intracerebral hemorrhage

et al. 2019

Euro J of Neurology

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“…We prospectively studied 1076 predominantly Chinese patients with a diagnosis of acute ischemic stroke who received a magnetic resonance imaging (MRI) scan incorporating a hemosiderin‐sensitive sequence at the University of Hong Kong MRI unit from March 1, 2008, to September 30, 2014 7, 8…”

Section: Methodsmentioning

confidence: 99%

“…4 We recently validated the prognostic value of the total SVD score and studied the prognostic implications of the individual components of the score, including microbleeds, in a large cohort of predominantly Chinese patients with ischemic stroke. 7 Because cerebral microbleeds are important predictors of subsequent ICH, we provide further details about the clinical and imaging correlates of microbleed burden and location and their long-term prognostic outcomes, stratified by antithrombotic use, in a large cohort of 1003 predominantly Chinese patients with ischemic stroke (%3100 patientyears of follow-up), using susceptibility-weighted imaging.…”

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confidence: 99%

Long‐Term Prognostic Implications of Cerebral Microbleeds in Chinese Patients With Ischemic Stroke

Lau

Wong

Teo

et al. 2017

JAHA

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BackgroundThis study was performed to determine the clinical correlates and long‐term prognostic implications of microbleed burden and location in Chinese patients with ischemic stroke.Methods and ResultsWe recruited 1003 predominantly Chinese patients with ischemic stroke who received magnetic resonance imaging at the University of Hong Kong. We determined the clinical correlates of microbleeds and the long‐term risks (3126 patient‐years of follow‐up) of recurrent ischemic stroke and intracerebral hemorrhage (ICH) by microbleed burden (0 versus 1, 2–4, and ≥5) and location, adjusting for age, sex, and vascular risk factors and stratified by antithrombotic use. Microbleeds were present in 450 of 1003 of the study population (119/450 had ≥5, 187/450 had mixed location). Having ≥5 microbleeds was independently associated with prior antiplatelet and anticoagulant use, whereas microbleeds of mixed location were independently associated with hypertension and prior anticoagulant use (all P<0.05). Microbleed burden was associated with an increased risk of ICH (microbleed burden versus no microbleeds: 1 microbleed: multivariate hazard ratio: 0.59 [95% confidence interval, 0.07–5.05]; 2–4 microbleeds: multivariate hazard ratio: 2.14 [95% confidence interval, 0.50–9.12]; ≥5 microbleeds: multivariate hazard ratio: 9.51 [95% confidence interval, 3.25–27.81]; P trend<0.0001), but the relationship of microbleed burden and risk of recurrent ischemic stroke was not significant (P trend=0.054). Similar findings were noted in the 862 of 1003 patients treated with antiplatelet agents only (ICH: P trend<0.0001; ischemic stroke P trend=0.096). Multivariate analysis revealed that, independent of vascular risk factors, antithrombotic use, and other neuroimaging markers of small vessel disease, having ≥5 microbleeds (multivariate hazard ratio: 6.08 [95% confidence interval, 1.11–33.21]; P=0.037) was identified as an independent predictor of subsequent ICH, but neither microbleed burden nor location was predictive of recurrent ischemic stroke risk.ConclusionsIn Chinese patients with ischemic stroke, a high burden of cerebral microbleeds was significantly associated with an increased risk of ICH; however, neither microbleed location nor burden was associated with recurrent ischemic stroke risk.

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“…2,3 Some researches about prediction of recurrent ischemic stroke are based on plaque morphology 4 and small vessel. 5 In addition, the eyes are embryological extension of the central nervous system (CNS) and can be detected easily. They have many similar neurophysiological The first two authors contributed equally to this study.…”

Section: Introductionmentioning

confidence: 99%

Visual field impairment predicts recurrent stroke after acute posterior circulation stroke and transient ischemic attack

et al. 2018

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Total small vessel disease score and risk of recurrent stroke

Cited by 167 publications

References 25 publications

Association between remote diffusion‐weighted imaging lesions and cerebral small vessel disease in primary intracerebral hemorrhage

Association between remote diffusion‐weighted imaging lesions and cerebral small vessel disease in primary intracerebral hemorrhage

Long‐Term Prognostic Implications of Cerebral Microbleeds in Chinese Patients With Ischemic Stroke

Visual field impairment predicts recurrent stroke after acute posterior circulation stroke and transient ischemic attack

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