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Cerebral small vessel disease or intracranial large vessel atherosclerosis may carry different risk for future strokes.
Stroke Vasc Neurol. 2020 Jun; 5(2):128-137.SV

Abstract

BACKGROUND

The effect of cerebral small vessel disease (CSVD) and intracranial arterial stenosis (ICAS) on stroke outcomes remains unclear.

METHODS

Data of 1045 patients with minor stroke or transient ischaemic attack (TIA) were obtained from 45 sites of the Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial. We assessed the associations of burdens of CSVD and ICAS with new strokes and bleeding events using multivariate Cox regression models and those with modified Rankin Scale (mRS) scores using ordinal logistic regression models.

RESULTS

Among the 1045 patients, CSVD was present in 830 cases (79.4%) and ICAS in 460 (44.0%). Patients with >1 ICAS segment showed the highest risk of new strokes (HR 2.03, 95% CI 1.15 to 3.56, p=0.01). No association between CSVD and the occurrence of new strokes was found. The presence of severe CSVD (common OR (cOR) 2.01, 95% CI 1.40 to 2.89, p<0.001) and >1 ICAS segment (cOR 2.15, 95% CI 1.57 to 2.93, p<0.001) was associated with higher mRS scores. Severe CSVD (HR 10.70, 95% CI 1.16 to 99.04, p=0.04), but not ICAS, was associated with a higher risk of bleeding events. Six-point modified CSVD score improved the predictive power for bleeding events and disability.

INTERPRETATION

CSVD is associated with more disability and bleeding events, and ICAS is associated with an increased risk of stroke and disability in patients with minor stroke and TIA at 3 months. CSVD and ICAS may represent different vascular pathologies and play distinct roles in stroke outcomes.

TRIAL REGISTRATION NUMBER

NCT00979589.

Authors+Show Affiliations

Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China. Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China.Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China. Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China.Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China. Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China.Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China. Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China.Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China. Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China.Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China. Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China.Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China. Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China.Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China. Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China.Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China. Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China.Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China. Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China.Dell Medical School, University of Texas, Austin, Texas, USA.Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China. Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China.Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China yilong528@gmail.com. China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China. Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32606085

Citation

Chen, Huimin, et al. "Cerebral Small Vessel Disease or Intracranial Large Vessel Atherosclerosis May Carry Different Risk for Future Strokes." Stroke and Vascular Neurology, vol. 5, no. 2, 2020, pp. 128-137.
Chen H, Pan Y, Zong L, et al. Cerebral small vessel disease or intracranial large vessel atherosclerosis may carry different risk for future strokes. Stroke Vasc Neurol. 2020;5(2):128-137.
Chen, H., Pan, Y., Zong, L., Jing, J., Meng, X., Xu, Y., Yan, H., Zhao, X., Liu, L., Li, H., Johnston, S. C., Wang, Y., & Wang, Y. (2020). Cerebral small vessel disease or intracranial large vessel atherosclerosis may carry different risk for future strokes. Stroke and Vascular Neurology, 5(2), 128-137. https://doi.org/10.1136/svn-2019-000305
Chen H, et al. Cerebral Small Vessel Disease or Intracranial Large Vessel Atherosclerosis May Carry Different Risk for Future Strokes. Stroke Vasc Neurol. 2020;5(2):128-137. PubMed PMID: 32606085.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cerebral small vessel disease or intracranial large vessel atherosclerosis may carry different risk for future strokes. AU - Chen,Huimin, AU - Pan,Yuesong, AU - Zong,Lixia, AU - Jing,Jing, AU - Meng,Xia, AU - Xu,Yuyuan, AU - Yan,Hongyi, AU - Zhao,Xingquan, AU - Liu,Liping, AU - Li,Hao, AU - Johnston,S Claiborne, AU - Wang,Yongjun, AU - Wang,Yilong, Y1 - 2020/04/15/ PY - 2019/11/12/received PY - 2019/11/26/revised PY - 2019/12/01/accepted PY - 2020/7/2/entrez PY - 2020/7/2/pubmed PY - 2020/7/2/medline KW - cerebral small vessel disease KW - intracranial arterial stenosis KW - stroke SP - 128 EP - 137 JF - Stroke and vascular neurology JO - Stroke Vasc Neurol VL - 5 IS - 2 N2 - BACKGROUND: The effect of cerebral small vessel disease (CSVD) and intracranial arterial stenosis (ICAS) on stroke outcomes remains unclear. METHODS: Data of 1045 patients with minor stroke or transient ischaemic attack (TIA) were obtained from 45 sites of the Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial. We assessed the associations of burdens of CSVD and ICAS with new strokes and bleeding events using multivariate Cox regression models and those with modified Rankin Scale (mRS) scores using ordinal logistic regression models. RESULTS: Among the 1045 patients, CSVD was present in 830 cases (79.4%) and ICAS in 460 (44.0%). Patients with >1 ICAS segment showed the highest risk of new strokes (HR 2.03, 95% CI 1.15 to 3.56, p=0.01). No association between CSVD and the occurrence of new strokes was found. The presence of severe CSVD (common OR (cOR) 2.01, 95% CI 1.40 to 2.89, p<0.001) and >1 ICAS segment (cOR 2.15, 95% CI 1.57 to 2.93, p<0.001) was associated with higher mRS scores. Severe CSVD (HR 10.70, 95% CI 1.16 to 99.04, p=0.04), but not ICAS, was associated with a higher risk of bleeding events. Six-point modified CSVD score improved the predictive power for bleeding events and disability. INTERPRETATION: CSVD is associated with more disability and bleeding events, and ICAS is associated with an increased risk of stroke and disability in patients with minor stroke and TIA at 3 months. CSVD and ICAS may represent different vascular pathologies and play distinct roles in stroke outcomes. TRIAL REGISTRATION NUMBER: NCT00979589. SN - 2059-8696 UR - https://www.unboundmedicine.com/medline/citation/32606085/Cerebral_small_vessel_disease_or_intracranial_large_vessel_atherosclerosis_may_carry_different_risk_for_future_strokes L2 - https://svn.bmj.com/cgi/pmidlookup?view=long&amp;pmid=32606085 DB - PRIME DP - Unbound Medicine ER -
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