Sperber Christoph, Hakim Arsany, Gallucci Laura, Arnold Marcel, Umarova Roza M
Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
J Stroke Cerebrovasc Dis. 2024 Apr;33(4):107589. doi: 10.1016/j.jstrokecerebrovasdis.2024.107589. Epub 2024 Jan 18.
Cerebral small vessel disease (SVD) has previously been associated with worse stroke outcome, vascular dementia, and specific post-stroke cognitive deficits. The underlying causal mechanisms of these associations are not yet fully understood. We investigated whether a relationship between SVD and certain stroke aetiologies or a specific stroke lesion anatomy provides a potential explanation.
In a retrospective observational study, we examined 859 patients with first-ever, non-SVD anterior circulation ischemic stroke (age = 69.0±15.2). We evaluated MRI imaging markers to assess an SVD burden score and mapped stroke lesions on diffusion-weighted MRI. We investigated the association of SVD burden with i) stroke aetiology, and ii) lesion anatomy using topographical statistical mapping.
With increasing SVD burden, stroke of cardioembolic aetiology was more frequent (ρ = 0.175; 95 %-CI = 0.103;0.244), whereas cervical artery dissection (ρ = -0.143; 95 %-CI = -0.198;-0.087) and a patent foramen ovale (ρ = -0.165; 95 %-CI = -0.220;-0.104) were less frequent stroke etiologies. However, no significant associations between SVD burden and stroke aetiology remained after additionally controlling for age (all p>0.125). Lesion-symptom-mapping and Bayesian statistics showed that SVD burden was not associated with a specific stroke lesion anatomy or size.
In patients with a high burden of SVD, non-SVD stroke is more likely to be caused by cardioembolic aetiology. The common risk factor of advanced age may link both pathologies and explain some of the existing associations between SVD and stroke. The SVD burden is not related to a specific stroke lesion location.
脑小血管病（SVD）此前一直与更差的卒中结局、血管性痴呆以及特定的卒中后认知缺陷相关。这些关联的潜在因果机制尚未完全明确。我们研究了SVD与某些卒中病因或特定的卒中病变解剖结构之间的关系是否能提供一种潜在解释。
在一项回顾性观察研究中，我们检查了859例首次发生的非SVD前循环缺血性卒中患者（年龄=69.0±15.2）。我们评估了MRI成像标志物以评估SVD负荷评分，并在扩散加权MRI上描绘卒中病变。我们使用地形统计映射研究了SVD负荷与i）卒中病因，以及ii）病变解剖结构之间的关联。
随着SVD负荷增加，心源性栓塞病因的卒中更为常见（ρ=0.175；95%-CI=0.103；0.244），而颈动脉夹层（ρ=-0.143；95%-CI=-0.198；-0.087）和卵圆孔未闭（ρ=-0.165；95%-CI=-0.220；-0.104）是较不常见的卒中病因。然而，在额外控制年龄后，SVD负荷与卒中病因之间无显著关联（所有p>0.125）。病变-症状映射和贝叶斯统计显示，SVD负荷与特定的卒中病变解剖结构或大小无关。
在SVD负担高的患者中，非SVD卒中更可能由心源性栓塞病因引起。高龄这一共同危险因素可能将两种病理联系起来，并解释了SVD与卒中之间一些现有的关联。SVD负担与特定的卒中病变位置无关。
