Abstract WP122: The Coexisting Leukoaraiosis In Ischemic Stroke Patients: How Does It Change Over Time?
Background: The prevalence of leukoaraiosis or white matter hyperintensities (WMH) is getting higher with the easy accessibility of brain imaging. Their clinical significance has not been known yet. Herein, we aimed to investigate how they progress or regress over time in patients with ischemic stroke.
Methods: We consecutively enrolled ischemic stroke patients who underwent brain MRI (T2-weighted image or fluid-attenuated inverse recovery (FLAIR) image) more than twice with at least a 6 month time-interval. Patients with pathologic lesions which cannot be distinguished from WMH were excluded. Clinical variables (age, sex, risk factors, stroke subtypes, and imaging time) were obtained by reviewing medical records. T2-weighted image or FLAIR image was used to assess the presence of WMH. WMH was visually measured with use of modified Fazekas grading by an independent investigator. The change of WMH was interpreted as 1)no change, 2)progress, 3)regression, 4)distinctive progress and regression. The descriptive analysis of the pattern of WMH change over time and factors associated with each pattern were analyzed.
Results: The total number of enrolled patients were 100. Their age (mean±SD) was 67.5±11.8 years and 63 were male. The most common stroke subtype was small vessel disease (SVD, 43%), followed by large vessel disease (LVD, 27%), and cardioembolism (9%). The imaging time-interval (mean±SD) was 28.0±16.6 months. In 64 patients, WMH was observed on brain MRI. Among them, the WMH pattern didn’t change in 25 patients, progressed in 28, regressed in 10 and progressed in distinctive region and regressed in others in 4 patients. Three patients had newly developed WMH on their follow-up MRI. 51.9% (14/27) of patients with LVD showed progress, whereas 30.2% (13/43) of SVD showed progress. Regarding regression, 16.3% (7/43) of patients with SVD, 11.1% (3/27) of LVD showed regression. The presence of LVD was significantly associated with WMH progression (14/27 vs. 18/73, p=0.015). The WMH changing pattern was not affected by risk factors.
Conclusions: Over half of patients with stroke showed progress of WMH on their follow-up MRI. In addition, regression of WMH was also observed in 21.8% patients. Stroke subtype of LVD was associated with WMH progression.
- © 2012 by American Heart Association, Inc.