Small vessel disease burden and risk of recurrent cerebrovascular events in patients with lacunar stroke and intracerebral haemorrhage attributable to deep perforator arteriolopathy.

Goeldlin, Martina B; Vynckier, Jan; Mueller, Madlaine; Drop, Boudewijn; Maamari, Basel; Vonlanthen, Noah; Siepen, Bernhard M; Hakim, Arsany; Kaesmacher, Johannes; Jesse, Christopher Marvin; Mueller, Mandy D; Meinel, Thomas R; Beyeler, Morin; Clénin, Leander; Gralla, Jan; Z'Graggen, Werner; Bervini, David; Arnold, Marcel; Fischer, Urs and Seiffge, David J (2023). Small vessel disease burden and risk of recurrent cerebrovascular events in patients with lacunar stroke and intracerebral haemorrhage attributable to deep perforator arteriolopathy. European stroke journal, 8(4), pp. 989-1000. Sage 10.1177/23969873231193237

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INTRODUCTION

Deep perforator arteriolopathy (DPA) causes intracerebral haemorrhage (ICH) and lacunar strokes (LS). We compare patient characteristics, MRI findings and clinical outcomes among patients with deep ICH and LS.

PATIENTS AND METHODS

We included patients with MRI-confirmed LS or ICH in the basal ganglia, thalamus, internal capsule or brainstem from the Bernese Stroke Registry. We assessed MRI small vessel disease (SVD) markers, SVD burden score, modified Rankin Scale (mRS) and ischaemic stroke or ICH at 3 months.

RESULTS

We included 716 patients, 117 patients (16.3%) with deep ICH (mean age (SD) 65.1 (±15.2) years, 37.1% female) and 599 patients (83.7%) with LS (mean age (SD) 69.7 (±13.6) years, 39.9% female). Compared to LS, deep ICH was associated with a higher SVD burden score (median (IQR) 2 (1-2) vs 1 (0-2)), aORshift 3.19, 95%CI 2.15-4.75). Deep ICH patients had more often cerebral microbleeds (deep ICH: 71.6% vs LS: 29.2%, p < 0.001, median count (IQR) 4(2-12) vs 2(1-6)) and a higher prevalence of lacunes (deep ICH: 60.5% vs LS: 27.4% p < 0.001). At 3 months, deep ICH was associated with higher mRS (aORshift 2.16, 95%CI 1.21-3.87). Occurrence of ischaemic stroke was numerically but not significantly higher in deep ICH (4.3% vs 2.9%; p = 0.51). One patient (1.1%) with ICH but none with LS suffered ICH recurrence.

DISCUSSION/CONCLUSION

DPA manifesting as ICH is associated with more severe MRI SVD burden and worse outcome compared to LS. The short-term risks of subsequent ischaemic stroke and recurrent ICH are similar in ICH and LS patients. This implies potential consequences for future secondary prevention strategies.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery

Graduate School:

Graduate School for Health Sciences (GHS)

UniBE Contributor:

Göldlin, Martina Béatrice, Vynckier, Jan Luc, Müller, Madlaine, Drop, Boudewijn Roderick Hinne, Maamari, Basel, Siepen, Bernhard Matthias, Hakim, Arsany, Kaesmacher, Johannes, Jesse, Christopher Marvin, Müller, Mandy, Meinel, Thomas Raphael, Beyeler, Morin, Clénin, Leander Caspar, Gralla, Jan, Z'Graggen, Werner Josef, Bervini, David, Arnold, Marcel, Fischer, Urs Martin, Seiffge, David Julian

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2396-9881

Publisher:

Sage

Language:

English

Submitter:

Pubmed Import

Date Deposited:

28 Aug 2023 13:35

Last Modified:

25 Nov 2023 00:13

Publisher DOI:

10.1177/23969873231193237

PubMed ID:

37632398

Uncontrolled Keywords:

Lacunar stroke MRI clinical outcomes deep perforator arteriopathy hypertension intracerebral haemorrhage neuroimaging

BORIS DOI:

10.48350/185781

URI:

https://boris.unibe.ch/id/eprint/185781

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