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Neurology. 2017 Jun 13;88(24):2260-2267. doi: 10.1212/WNL.0000000000004042. Epub 2017 May 17.

Total small vessel disease score and risk of recurrent stroke: Validation in 2 large cohorts.

Author information

1
From the Centre for Prevention of Stroke and Dementia (K.K.L., L.L., U.S., M.S., W.K., P.M.R.), Nuffield Department of Clinical Neurosciences, University of Oxford, UK; and Division of Neurology, Department of Medicine (K.K.L., K.H.C., S.L.H., R.T.F.C.), and Department of Diagnostic Radiology (H.K.F.M.), Li Ka Shing Faculty of Medicine, University of Hong Kong.
2
From the Centre for Prevention of Stroke and Dementia (K.K.L., L.L., U.S., M.S., W.K., P.M.R.), Nuffield Department of Clinical Neurosciences, University of Oxford, UK; and Division of Neurology, Department of Medicine (K.K.L., K.H.C., S.L.H., R.T.F.C.), and Department of Diagnostic Radiology (H.K.F.M.), Li Ka Shing Faculty of Medicine, University of Hong Kong. peter.rothwell@ndcn.ox.ac.uk.

Abstract

OBJECTIVE:

In patients with TIA and ischemic stroke, we validated the total small vessel disease (SVD) score by determining its prognostic value for recurrent stroke.

METHODS:

Two independent prospective studies were conducted, one comprising predominantly Caucasian patients with TIA/ischemic stroke (Oxford Vascular Study [OXVASC]) and one predominantly Chinese patients with ischemic stroke (University of Hong Kong [HKU]). Cerebral MRI was performed and assessed for lacunes, microbleeds, white matter hyperintensities (WMH), and perivascular spaces (PVS). Predictive value of total SVD score for risk of recurrent stroke was determined and potential refinements considered.

RESULTS:

In 2,002 patients with TIA/ischemic stroke (OXVASC n = 1,028, HKU n = 974, 6,924 patient-years follow-up), a higher score was associated with an increased risk of recurrent ischemic stroke (adjusted hazard ratio [HR] per unit increase: 1.32, 1.16-1.51, p < 0.0001; c statistic 0.61, 0.56-0.65, p < 0.0001) and intracerebral hemorrhage (ICH) (HR 1.54, 1.11-2.13, p = 0.009; c statistic 0.65, 0.54-0.76, p = 0.006). A higher score predicted recurrent stroke in SVD and non-SVD TIA/ischemic stroke subtypes (c statistic 0.67, 0.59-0.74, p < 0.0001 and 0.60, 0.55-0.65, p < 0.0001). Including burden of microbleeds and WMH and adjusting the cutoff of basal ganglia PVS potentially improved predictive power for ICH (c statistic 0.71, 0.60-0.81, phet = 0.45), but not for recurrent ischemic stroke (c statistic 0.60, 0.56-0.65, phet = 0.76) on internal validation.

CONCLUSIONS:

The total SVD score has predictive value for recurrent stroke after TIA/ischemic stroke. Prediction of recurrence in patients with nonlacunar events highlights the potential role of SVD in wider stroke etiology.

PMID:
28515266
PMCID:
PMC5567324
DOI:
10.1212/WNL.0000000000004042
[Indexed for MEDLINE]
Free PMC Article

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