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White matter hyperintensities and recurrent stroke risk in patients with stroke with small-vessel disease

Title
White matter hyperintensities and recurrent stroke risk in patients with stroke with small-vessel disease
Author
박종호
Keywords
magnetic resonance imaging; recurrent; small-vessel disease; stroke; white matter hyperintensities
Issue Date
2019-06
Publisher
WILEY
Citation
EUROPEAN JOURNAL OF NEUROLOGY, v. 29, NO 6, Page. 911-918
Abstract
Background and purposeWhite matter hyperintensities (WMH) are a predictor of stroke among elderly individuals. This study aimed to evaluate the association between WMH severity and the risk of recurrent vascular events among Asian patients with ischaemic stroke with small-vessel disease (SVD) including micro/macrobleeds and lacunes. MethodsData from participants (n=1454) in the PICASSO (PreventIon of CArdiovascular Events in iSchemic Stroke Patients with High Risk of Cerebral HemOrrhage) trial were reviewed. The severity of WMH in baseline brain magnetic resonance imaging scans was assessed using the Fazekas scale. The association between WMH severity and stroke (ischaemic or hemorrhagic) and major vascular events (MVEs) (a composite of stroke/myocardial infarction/vascular death) was assessed. ResultsStudy patients had a significant burden of SVD: Fazekas score 0 (n=2), 1 (n=426), 2 (n=650) and 3 (n=376) [median Fazekas score 2 (mean follow-up, 1.9 1.3 years)]. The stroke incidence rate per 100 personyears was 2.6 in the Fazekas 0-1 group, 3.6 in the Fazekas 2 group and 7.0 in the Fazekas 3 group, and the rates for MVEs were 3.3, 4.3 and 7.6, respectively. Compared with the Fazekas 0-1 group, the Fazekas 3 group was associated with a higher risk of stroke [adjusted hazard ratio (HR), 2.15; 95% confidence interval (CI), 1.19-3.88; P=0.011], ischaemic stroke (adjusted HR, 2.11; 95% CI, 1.07-4.15; P=0.031), hemorrhagic stroke (adjusted HR, 3.72; 95% CI, 1.09-12.70; P=0.036) and MVEs (adjusted HR, 2.09; 95% CI, 1.20-3.66; P=0.010). ConclusionAdvanced WMH in Asian patients with ischaemic stroke with SVD burden was associated with an increased risk of recurrent vascular events. It may exert an effect as a prognostic indicator in high risk of recurrent vascular events.
URI
https://onlinelibrary.wiley.com/doi/full/10.1111/ene.13908https://repository.hanyang.ac.kr/handle/20.500.11754/110607
ISSN
1351-5101; 1468-1331
DOI
10.1111/ene.13908
Appears in Collections:
COLLEGE OF MEDICINE[S](의과대학) > MEDICINE(의학과) > Articles
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