Stroke Unit-Medical Department of Continuity of Care and Disability, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Italy.
Department of Medical and Surgical Sciences, University of Bologna, Italy.
J Stroke Cerebrovasc Dis. 2021 Sep;30(9):105946. doi: 10.1016/j.jstrokecerebrovasdis.2021.105946. Epub 2021 Jun 29.
Cerebral small vessel disease (SVD) is often associated with hypertension and may evolve towards intracerebral hemorrhage (ICH) or lacunar ischemic stroke. However, the factors favoring the evolution towards ICH or lacunar stroke are not well understood.
This retrospective study included 326 consecutive patients (71.1±13.2 years, 38% women): 143 with deep ICH and 183 with lacunar lesions (LL) <2 cm, which were visible in a deep location on brain CT scan. Among LL patients, 143 had a small-artery occlusion (SAO) stroke according to the TOAST classification. Clinical characteristics plus laboratory and neuroradiological variables of these patients had been prospectively collected and a subgroup underwent echocardiography.
In multivariate analysis, ICH patients (97% hypertensive), compared to SAO patients (89% hypertensive), had greater left ventricular wall thickness (LVWT; OR 4.15, 95%CI 1.64-10.53, for those with LVWT ≥ 1.4 cm, 70% of whom were hemorrhagic) and lower prevalence of white matter lesions (OR 0.30, 95%CI 0.13-0.70), ever smokers (OR 0.39, 95%CI 0.18-0.82) and diabetics (OR 0.29, 95% CI 0.10-0.84). Moreover, ICH patients had a greater prevalence of atrial fibrillation than LL patients (OR 3.14, 95%CI 1.11-8.93), and so they were more often anticoagulated.
Most SVD patients were hypertensive, but those evolving towards ICH were characterized by organ damage at the cardiac level (increase in LVWT and atrial fibrillation), while those evolving towards lacunar stroke were characterized by a higher prevalence of smokers and diabetics, and by organ damage at the cerebral level (white matter lesions).
脑小血管病（SVD）常与高血压有关，可能发展为脑出血（ICH）或腔隙性缺血性卒中。然而，有利于向 ICH 或腔隙性卒中发展的因素尚不清楚。
本回顾性研究纳入了 326 例连续患者（71.1±13.2 岁，38%为女性）：143 例为深部 ICH，183 例为腔隙病变（LL）<2cm，在脑 CT 扫描中可见于深部位置。在腔隙性病变患者中，143 例根据 TOAST 分类为小动脉闭塞（SAO）卒中。前瞻性收集了这些患者的临床特征、实验室和神经影像学变量，并对亚组进行了超声心动图检查。
多变量分析显示，ICH 患者（97%为高血压患者）与 SAO 患者（89%为高血压患者）相比，左心室壁厚度（LVWT）更大（OR 4.15，95%CI 1.64-10.53，对于 LVWT≥1.4cm 的患者，70%为出血性），且白质病变（OR 0.30，95%CI 0.13-0.70）、曾吸烟者（OR 0.39，95%CI 0.18-0.82）和糖尿病患者（OR 0.29，95%CI 0.10-0.84）的比例较低。此外，ICH 患者的心房颤动发生率高于腔隙性病变患者（OR 3.14，95%CI 1.11-8.93），因此他们更常接受抗凝治疗。
大多数 SVD 患者为高血压患者，但向 ICH 发展的患者以心脏水平的器官损伤为特征（LVWT 增加和心房颤动），而向腔隙性卒中发展的患者则以吸烟和糖尿病患者比例较高、脑水平的器官损伤（白质病变）为特征。
