Abstract 96: Neuroimaging Markers of Small Vessel Disease Differ Between Types of Recent Small Subcortical Infarcts
Background: The current neuroimaging standards of small vessel disease favor classification of all patients with a recent infarction in the territory of one perforating artery under the umbrella term of recent small subcortical infarcts (RSSI). Nonetheless the pathophysiology of perforator artery stroke is heterogeneous (microatheroma formation, lipohyalinosis or embolism), which is reflected by different infarct patterns on imaging studies. In this study, our aim was to determine whether chronic imaging markers of small vessel disease vary among patients with different imaging features of RSSI.
Methods: Features of small vessel disease (lacunes, microbleeds, perivascular spaces, white matter hyperintensities) were rated and small vessel disease burden score was determined in a consecutive series of 242 ischemic stroke patients admitted with RSSI. Small subcortical infarcts were dichotomized into proximal and distal patterns based on their proximity to the parent artery. Radiological and clinical features were compared among these groups by univariate and multivariate analyses.
Results: The cardiovascular risk factor profiles were similar between both groups. Patients with proximal pattern (n=63) more likely had an alternate stroke etiology other than small artery occlusion, like cardioembolism or proximal large vessel atherosclerosis (p=0.03). On radiologic evaluation, chronic lacune (p=0.03), microbleed (p=0.05) and periventricular white matter hyperintensity (p=0.04) burden, as well as the burden score (p=0.05) was significantly higher among patients with distal pattern. Multivariate analyses, which took into account the effect of age and cardiovascular risk factors, showed a significant association between higher small vessel burden score and the distal small subcortical infarction pattern (p<0.01).
Conclusion: There is significant heterogeneity among patients with RSSI with respect to neuroimaging markers of small vessel disease. These markers, together with lesion patterns, might prove to be useful in accurately identifying different subgroups of RSSI, which would be critical in understanding of the relevant pathopysiology and development of appropriate treatment strategies.
Author Disclosures: E. Arsava: None. B. Acar: None. B. Kaplan: None. R. Gocmen: None. M. Topcuoglu: None.
- © 2016 by American Heart Association, Inc.