Pre-Existing Cerebral Small Vessel Disease Limits Early Recovery in Patients with Acute Lacunar Infarct

• Published in: Journal of stroke and cerebrovascular diseases 2019-11, Vol.28 (11), p.104312-104312, Article 104312
• Main Authors: Gómez-Choco, Manuel, Mengual, Juan José, Rodríguez-Antigüedad, Jon, Paré-Curell, Martí, Purroy, Francisco, Palomeras, Ernest, Fuentes, Blanca, Ustrell, Xavier, Tembl, José, Rodríguez-Yañez, Manuel, Castellanos, Mar, Martí-Fabregas, Joan, Serena, Joaquín
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Cerebral Small Vessel Diseases - complications; Cerebral Small Vessel Diseases - diagnostic imaging; Cerebral Small Vessel Diseases - physiopathology; Disability Evaluation; Female; Humans; lacunar stroke; lacune; Male; microbleed; Middle Aged; Recovery of Function; Registries; Retrospective Studies; Risk Factors; Small vessel disease; stroke recovery; Stroke Rehabilitation; Stroke, Lacunar - complications; Stroke, Lacunar - diagnosis; Stroke, Lacunar - physiopathology; Stroke, Lacunar - therapy; Time Factors; Treatment Outcome; white matter hyperintensity
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2019.104312

Background and Purpose: To assess whether neuroimaging markers of chronic cerebral small vessel disease (cSVDm) influence early recovery after acute ischemic stroke (AIS). Methods: Retrospective analysis of patients diagnosed with AIS and included in the Spanish Neurological Society Stroke Database. Inclusion criteria: (1) Brain MRI performed after acute stroke and (2) Premorbid modified Rankin scale (mRS) = 0. Exclusion criteria: (1) Uncommon stroke etiologies, (2) AIS not confirmed on neuroimaging, or (3) Old territorial infarcts on neuroimaging. Patients scored from 0 to 2 according to the amount of cSVDm. Patients were divided into lacunar ischemic stroke (LIS) and nonlacunar ischemic stroke (NLIS) groups according to TOAST classification. Primary outcome: Distribution of mRS at discharge. Secondary outcomes: NIHSS improvement more than or equal to 3 at 24 hours and at discharge, NIHSS worsening more than or equal to 3 points at 24 hours. Results: We studied 4424 patients (3457 NLIS, 967 LIS). The presence of cSVDm increased the risk of worsening 1 category on the mRS at discharge in the LIS group ([1] cSVDm: OR 1.89 CI 95% 1.29-2.75, P = .001. [2] cSVDm: OR 1.87, CI 95% 1.37-2.56 P = .001) and was an independent factor for not achieving an improvement more than or equal to 3 points on the NIHSS at discharge for all the patients and the LIS group (all stroke patients: [1] cSVDm: OR 0.81 CI 95% .68-.97 P = .022. [2] cSVD: OR 0.58 CI95% .45-.77, P = .001./LIS: [1] cSVDm: OR 0.64, CI 95% .41-.98, P = .038. [2] cSVDm: OR 0.43, CI 95% .24-.75 P = .003). Conclusions: Pre-existing SVD limits early functional and neurological recovery after AIS, especially in LIS patients.