Cerebral Small Vessel Disease is Associated with Prehospital Delay in Acute Ischemic Stroke

• Published in: Journal of Atherosclerosis and Thrombosis 2024, pp.64968
• Main Authors: Masui, Marina, Sato, Takeo, Okumura, Motohiro, Ishikawa, Takahiro, Sakuta, Kenichi, Kokubu, Tatsushi, Takahashi, Junichiro, Kitagawa, Tomomichi, Tanabe, Maki, Onda, Asako, Komatsu, Teppei, Sakai, Kenichiro, Umehara, Tadashi, Mitsumura, Hidetaka, Iguchi, Yasuyuki
• Format: Article
• Language: English
• Subjects: Acute ischemic stroke; Cerebral small vessel disease; Enlarged perivascular spaces; Onset-to-door time; Prehospital delay
• ISSN: 1340-3478; 1880-3873; 1880-3873
• DOI: 10.5551/jat.64968

Aim: To determine whether the severity of cerebral small vessel disease (SVD) is associated with prehospital delay in acute ischemic stroke.Methods: Consecutive patients with ischemic stroke were included in this study. We evaluated the SVD burden using the total SVD score. Patients were divided into 2 groups: onset-to-door time within 4.5 hours (early arrival group) and onset-to-door time over 4.5 hours (delayed arrival group). First, we assessed whether the total SVD score was related to prehospital delay using a logistic regression analysis. Second, we assessed which item of the score was independently associated with delays. Finally, we determined whether the item had a linear association with the delay.Results: Of the 2,112 screened patients, 1,754 were enrolled in the study (1,253 males [71%]; median age, 69 years). There were 1,105 patients (63%) in the delayed arrival group. The total SVD score was independently associated with delay (OR 1.11, 95% CI 1.01–1.21, p=0.025). Among the 4 items of the score, only enlarged perivascular spaces (EPVS) in the basal ganglia was independently associated with delay (OR 1.37, 95% CI 1.05–1.80, p=0.022). A linear trend was observed between EPVS grade and delay with reference to EPVS grade 0–1 (EPVS grade 2: OR 1.22, 95% CI 0.92–1.62, p=0.170, EPVS grade 3: OR 1.69, 95% CI 1.20–2.38, p=0.002, EPVS grade 4: OR 2.17, 95% CI 1.37–3.44, p=0.001).Conclusions: Prehospital delay in acute ischemic stroke could be associated with the severity of SVD, particularly EPVS in the basal ganglia.