From the Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (G.-M.K.); Department of Radiology, A.A. Martinos Center for Biomedical Imaging (G.-M.K., K.-Y.P., R.A., J.H., B.R., H.A.) and Department of Neurology, Stroke Service (N.R., J.R., H.A.), Massachusetts General Hospital, Harvard Medical School, Boston; and Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea (K.-Y.P.).
Stroke. 2014 Feb;45(2):479-85. doi: 10.1161/STROKEAHA.113.003004. Epub 2013 Dec 26.
The integrity of white matter tracts connecting different parts of the brain is important for rapid compensation for the lost function from ischemic stroke. Impaired white matter reserve capacity secondary to leukoaraiosis may facilitate detection of new symptomatic ischemic events that would otherwise remain inconspicuous after an initial ischemic stroke. We sought to identify whether the extent of leukoaraiosis was a predictor of risk of early stroke recurrence.
We used Cox regression analysis in consecutive patients with ischemic stroke to determine the relationship between leukoaraiosis burden and symptomatic stroke recurrence within 90 days. We graded total leukoaraiosis, periventricular leukoaraiosis, and subcortical leukoaraiosis using the Fazekas scale as mild (<2) and extensive (≥2) on fluid-attenuated inversion recovery images obtained within 72 hours of stroke onset in the hemisphere contralateral to acute stroke.
There were 106 recurrent events in 2378 patients. The cumulative incidence of recurrence was 5.9% at 90 days. Kaplan-Meier estimate of recurrence-free survival rate was lower in patients with extensive leukoaraiosis (P=0.04) and extensive periventricular leukoaraiosis (P=0.02) but not in extensive subcortical leukoaraiosis (P=0.09). Multivariable Cox regression analysis revealed a hazard ratio of 1.50 (95% confidence interval, 1.00-2.25) for extensive leukoaraiosis, 1.67 (95% confidence interval, 1.11-2.51) for extensive periventricular leukoaraiosis, and 1.42 (95% confidence interval, 0.94-2.12) for extensive subcortical leukoaraiosis.
The extent of leukoaraiosis independently predicts 90-day recurrent stroke risk after ischemic stroke. This suggests that leukoaraiosis may be used for risk stratification in ischemic stroke.
连接大脑不同部位的白质束的完整性对于迅速补偿缺血性中风导致的功能丧失很重要。由于脑白质疏松症导致的白质储备能力受损，可能会更容易发现新的症状性缺血性事件，否则这些事件在初次缺血性中风后可能不会被察觉。我们试图确定脑白质疏松症的严重程度是否是早期中风复发风险的预测因素。
我们使用连续的缺血性中风患者的 Cox 回归分析，确定脑白质疏松症负担与 90 天内症状性中风复发之间的关系。我们使用 Fazekas 量表在中风发作后 72 小时内获得的对侧急性中风半球的液体衰减反转恢复图像上对总脑白质疏松症、脑室周围脑白质疏松症和皮质下脑白质疏松症进行分级，分为轻度（<2）和广泛（≥2）。
在 2378 例患者中，有 106 例发生了复发事件。90 天的累积复发率为 5.9%。Kaplan-Meier 估计的无复发生存率在广泛脑白质疏松症（P=0.04）和广泛脑室周围脑白质疏松症（P=0.02）患者中较低，但在广泛皮质下脑白质疏松症患者中（P=0.09）则没有。多变量 Cox 回归分析显示，广泛脑白质疏松症的危险比为 1.50（95%置信区间，1.00-2.25），广泛脑室周围脑白质疏松症的危险比为 1.67（95%置信区间，1.11-2.51），广泛皮质下脑白质疏松症的危险比为 1.42（95%置信区间，0.94-2.12）。
脑白质疏松症的严重程度独立预测缺血性中风后 90 天内的复发性中风风险。这表明脑白质疏松症可用于缺血性中风的风险分层。
