Arba F, Inzitari D, Ali M, Warach S J, Luby M, Lees K R
NEUROFARBA Department, University of Florence, Florence, Italy.
Institute of Cardiovascular and Medical Sciences, Queen Elizabeth University Hospital Glasgow, Glasgow, UK.
Acta Neurol Scand. 2017 Jul;136(1):72-77. doi: 10.1111/ane.12745. Epub 2017 Feb 23.
Cerebral small vessel disease (SVD) contributes to dementia and disability in the elderly, and may negatively affect stroke outcomes. We aimed to evaluate to what extent single features and global burden of SVD detected with magnetic resonance (MR) are associated with worse outcomes in patients with ischaemic stroke treated with intravenous thrombolysis.
We accessed anonymized data and MR images from the Stroke Imaging Repository (STIR) and the Virtual International Stroke Trials Archive (VISTA) Imaging. We described SVD features using validated scales and quantified the global burden of SVD with a combined score. Our mainoutcome was the modified Rankin Scale (mRS) at 90 days after stroke. We used logistic regression and ordinal regression models (adjusted for age, sex, stroke severity, onset to treatment time) to examine the associations between each SVD feature, SVD global burden and clinical outcomes.
A total of 259 patients had MR scans available at baseline (mean age±SD=68.7±15.5 years; 131 [49%] males). After adjustment for confounders, severe white matter changes were associated with disability (OR=5.14; 95%CI=2.30-11.48), functional dependency (OR=4.38; 95%CI=2.10-9.13) and worse outcomes in ordinal analysis (OR=2.71; 95%CI=1.25-5.85). SVD score was associated with disability (OR=1.66; 95%CI=1.03-2.66) and functional dependency (OR=1.47; 95%CI=1.00-2.45). Lacunes, enlarged perivascular spaces and brain atrophy showed no association with clinical outcomes.
Our results suggest that SVD negatively affects stroke outcomes after intravenous thrombolysis. Although white matter changes seem to be the major driver in relation to worse outcomes, global estimation of SVD is feasible and may provide helpful information.
脑小血管病（SVD）会导致老年人痴呆和残疾，并可能对中风预后产生负面影响。我们旨在评估磁共振（MR）检测到的SVD单一特征和整体负担在多大程度上与接受静脉溶栓治疗的缺血性中风患者的较差预后相关。
我们从卒中影像库（STIR）和虚拟国际卒中试验档案（VISTA）影像中获取了匿名数据和MR图像。我们使用经过验证的量表描述SVD特征，并用综合评分量化SVD的整体负担。我们的主要结局是中风后90天的改良Rankin量表（mRS）。我们使用逻辑回归和有序回归模型（根据年龄、性别、中风严重程度、发病至治疗时间进行调整）来研究每个SVD特征、SVD整体负担与临床结局之间的关联。
共有259例患者在基线时进行了MR扫描（平均年龄±标准差=68.7±15.5岁；131例[49%]为男性）。在对混杂因素进行调整后，严重的白质改变与残疾（比值比=5.14；95%置信区间=2.30-11.48）、功能依赖（比值比=4.38；95%置信区间=2.10-9.13）以及有序分析中的较差结局相关（比值比=2.71；95%置信区间=1.25-5.85）。SVD评分与残疾（比值比=1.66；95%置信区间=1.03-2.66）和功能依赖（比值比=1.47；95%置信区间=1.00-2.45）相关。腔隙、血管周围间隙扩大和脑萎缩与临床结局无关。
我们的结果表明，SVD对静脉溶栓后的中风预后有负面影响。尽管白质改变似乎是导致较差预后的主要因素，但对SVD进行整体评估是可行的，并且可能提供有用信息。
