Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China.
Department of Computed Tomography and Magnetic Resonance Imaging, Xuzhou Center Hospital, Xuzhou, 221009, China.
Eur Radiol. 2022 Oct;32(10):6943-6952. doi: 10.1007/s00330-022-08792-6. Epub 2022 Apr 26.
We aimed to investigate the additional significance of cerebral small vessel disease (SVD) beyond collaterals in determining the clinical outcome after acute ischemic stroke (AIS).
We retrospectively reviewed large vessel-involved stroke patients who had baseline CTA within 24 h after symptom onset and had an MRI scan 5 days after admission from October 1, 2018, to October 31, 2021. Collaterals and SVD markers (including atrophy, leukoaraiosis, lacunes, and perivascular space) were graded on CT angiography and MR images, respectively. Modified Rankin Scale (mRS) score at 90 days was recorded, and mRS ≤ 2 was regarded as a good clinical outcome. The associations between SVD markers, collaterals, and mRS were analyzed using logistic and causal mediation regression.
We finally enrolled 119 patients (70 ± 13 years). The multivariable regression showed atrophy (evidence: OR 0.05 [95% CI 0.01-0.31], p = 0.002; severe: OR 0.08 [95% CI 0.01-0.44], p = 0.007) and evidence of lacune (OR 0.30 [95% CI 0.08-0.96], p = 0.049) were associated with poor clinical outcomes after correcting covariables. Collaterals mediated 25.74% of the effect of atrophy on poor clinical outcomes (p < 0.001), while lacune impacted clinical outcomes without collaterals' mediation effect (p = 0.54). The classification model with atrophy and lacune had a significantly higher AUC than without markers to distinguish good and poor outcomes (p = 0.036).
Beyond collaterals, brain frailty, specifically assessed by atrophy and lacune, was essential in evaluating stroke patients and could additionally improve the stroke outcome prediction.
• Beyond collaterals, brain frailty, specifically assessed by brain atrophy and lacune, was still an independent risk factor of unfavorable clinical outcomes after AIS. • Adding brain atrophy and lacune into the model has an extra benefit in predicting stroke outcomes. • The effect of atrophy on stroke outcomes was proportionally mediated through collaterals, but about three-quarters of the effect of brain atrophy and the total effect of lacune directly impacted stroke outcomes without a mediation effect of collaterals.
我们旨在探讨脑小血管病（SVD）在决定急性缺血性脑卒中（AIS）后临床转归方面的作用是否超过侧支循环。
我们回顾性分析了 2018 年 10 月 1 日至 2021 年 10 月 31 日期间发病后 24 小时内进行基线 CTA 检查且入院后 5 天内行 MRI 扫描的大血管受累脑卒中患者。在 CT 血管造影和 MR 图像上分别对侧支循环和 SVD 标志物（包括脑萎缩、脑白质疏松、腔隙和血管周围间隙）进行分级。记录 90 天时的改良 Rankin 量表（mRS）评分，mRS≤2 为良好临床结局。使用逻辑回归和因果中介回归分析 SVD 标志物、侧支循环与 mRS 的相关性。
我们最终纳入 119 例患者（70±13 岁）。多变量回归显示脑萎缩（证据：OR 0.05[95%CI 0.01-0.31]，p=0.002；严重：OR 0.08[95%CI 0.01-0.44]，p=0.007）和腔隙证据（OR 0.30[95%CI 0.08-0.96]，p=0.049）与校正混杂因素后不良临床结局相关。侧支循环介导了脑萎缩对不良临床结局影响的 25.74%（p<0.001），而腔隙不通过侧支循环的中介作用影响临床结局（p=0.54）。有脑萎缩和腔隙标志物的分类模型在区分良好结局和不良结局方面的 AUC 显著高于无标志物模型（p=0.036）。
除侧支循环外，脑萎缩（具体通过脑萎缩和腔隙评估）是评估脑卒中患者的重要指标，可进一步改善脑卒中患者的预后预测。
