Choroba małych naczyń – Rokowania, prognozy i postęp choroby

Choroba małych naczyń
Rokowania, prognozy i postęp choroby

Choroba małych naczyń mózgowych (CSVD) jest kluczowym czynnikiem ryzyka udarów mózgu (25% przypadków) oraz demencji (45%). Biomarkery CSVD, takie jak hiperintensywności istoty białej (WMH), zanik korowy i głęboki, oraz mikrokrwawienia, wykazują istotne powiązania z gorszymi wynikami funkcjonalnymi po krwotoku śródmózgowym (ICH) i ostrym udarze niedokrwiennym (AIS). W modelach wieloczynnikowych OR dla WMH wynosi 1,52 (95% CI 1,12-2,06), dla zaniku korowego 1,80 (95% CI 1,19-2,73), a dla ciężkiego zaniku 1,94 (95% CI 1,36-2,74). Liczba mikrokrwawień poprawia predykcję wyniku udaru (p=0,002), a obecność lakunowych ognisk niedokrwiennych również istotnie wpływa na rokowanie (p=0,01). Całkowite obciążenie CSVD, oceniane w MRI, modyfikuje efekty leczenia chirurgicznego i jest powiązane z jakością życia (HRQoL), zwłaszcza w domenach mobilności i widzenia, 3 miesiące po udarze.

Prognozy choroby małych naczyń (Small vessel disease prognosis)

Rokowanie funkcjonalne po udarze krwotocznym
Rokowanie po udarze niedokrwiennym
Jakość życia związana ze zdrowiem po udarze
Przewidywanie ryzyka demencji
Rola nowych technik obrazowania w prognozowaniu
Implikacje dla badań klinicznych
Rola CSVD w kontekscie leczenia endowaskularnego

Czynniki wpływające na prognozę

Kolejne rozdziały

Prognozy choroby małych naczyń (Small vessel disease prognosis)

Choroba małych naczyń mózgowych (CSVD) stanowi istotny problem kliniczny, odpowiadając za 25% udarów mózgu i przyczyniając się do 45% przypadków demencji. ¹ Rokowanie w tej chorobie zależy od wielu czynników, a najnowsze badania dostarczają coraz więcej danych na temat czynników predykcyjnych i możliwości prognostycznych w tej jednostce chorobowej.

Rokowanie funkcjonalne po udarze krwotocznym

Biomarkery choroby małych naczyń widoczne w badaniu CT wykazują istotny związek z 6-miesięcznym wynikiem funkcjonalnym po krwotoku śródmózgowym (ICH). W modelach wieloczynnikowych (skorygowanych o składniki skali ICH) obecność hiperintensywności istoty białej (WMH) (iloraz szans [OR] 1.52, 95% przedział ufności [CI] 1.12-2.06), obecność zaniku korowego (OR 1.80, 95% CI 1.19-2.73), obecność zaniku głębokiego (OR 1.66, 95% CI 1.17-2.34) oraz ciężki zanik (zarówno głęboki, jak i korowy) (OR 1.94, 95% CI 1.36-2.74) były niezależnie związane z gorszym wynikiem funkcjonalnym. ² Skala ICH ma akceptowalną moc dyskryminacyjną do przewidywania 6-miesięcznego wyniku funkcjonalnego po krwotoku śródmózgowym, jednak dodanie biomarkerów CSVD nie poprawia znacząco tej mocy dyskryminacyjnej. ³

Badania wykazują, że po skutecznej redukcji krwiaka poprzez minimalnie inwazyjną chirurgię (MIS), istotnie niższe szanse na zły wynik funkcjonalny występują u pacjentów z mniejszym całkowitym obciążeniem CSVD, a także przy braku lakunowych ognisk niedokrwiennych i ciężkich hiperintensywności istoty białej. ⁴ Całkowite obciążenie CSVD w obrazowaniu MRI mózgu, a zwłaszcza obecność ciężkich hiperintensywności istoty białej i lakunowych ognisk niedokrwiennych, znacząco modyfikuje efekt skutecznego zabiegu chirurgicznego na niekorzystny wynik. ⁵

Rokowanie po udarze niedokrwiennym

Liczba mikrokrwawień ocenianych w sposób ciągły oraz obecność lakunowych ognisk niedokrwiennych są związane z wynikiem udaru niezależnie od wieku, ciężkości udaru, niepełnosprawności przed udarem i innych cech CSVD. ⁶ Analiza modelu z ciągłą oceną cech CSVD wykazała, że liczba mikrokrwawień w momencie udaru poprawiła przewidywanie wyniku udaru (p=0,002), podczas gdy inne parametry CSVD, takie jak poszerzone przestrzenie okołonaczyniowe (EPVS), hiperintensywności istoty białej (WMH) i liczba lakunowych ognisk niedokrwiennych, nie miały takiego wpływu. ⁷

W modelu z binarną oceną cech CSVD, obecność lakunowych ognisk niedokrwiennych poprawiła przewidywanie wyniku udaru (p=0,01). ⁸ Liczba mikrokrwawień poprawiła przewidywanie wyniku udaru, podczas gdy sama obecność lub brak jednego mikrokrwawienia (model binarny) nie była informatywna dla modelu predykcyjnego. ⁹

Badania prospektywne wykazały, że obciążenie chorobą małych naczyń mózgowych (cSVD) było znacząco wyższe u pacjentów z gorszym wynikiem funkcjonalnym przy wypisie oraz 12 miesięcy po incydencie naczyniowo-mózgowym. ¹⁰ Obciążenie cSVD było predyktorem złego wyniku (OR 2,8; p≤0,001). ¹¹ Znaleziono istotny związek między średnim ciśnieniem rozkurczowym w ciągu 72 godzin (DBP72h) (p≤0,01), cSVD (p=0,013) a wynikiem przy wypisie. Po 12 miesiącach stwierdzono związek między wynikiem a DBP72h (p=0,018) oraz tendencję statystyczną dotyczącą cSVD (p=0,08). ¹²

Rosnąca liczba badań sugeruje, że cSVD u pacjentów z ostrym udarem niedokrwiennym (AIS) jest niezależnie związana z gorszym wynikiem funkcjonalnym w krótkim i długim terminie po incydencie naczyniowo-mózgowym. ¹³ Obciążenie cSVD nie przewidywało istotnie złego wyniku po 12 miesiącach, niemniej jednak istniała tendencja statystyczna (OR 1,69; 95% CI 0,94-3,04; p=0,08). ¹⁴

Jakość życia związana ze zdrowiem po udarze

Obciążenie mózgu chorobą małych naczyń przewiduje niższą jakość życia związaną ze zdrowiem (HRQoL), głównie w domenach mobilności i widzenia 3 miesiące po ostrym udarze niedokrwiennym. ¹⁵ Głównym ustaleniem badania jest to, że obciążenie SVD, obejmujące całkowite uszkodzenie mózgu wynikające z SVD, było niezależnie i negatywnie związane z HRQoL, szczególnie w domenach mobilności i widzenia. ¹⁶

Badania sugerują, że przesiewowa ocena wyjściowego obciążenia SVD może pomóc w identyfikacji pacjentów udarowych z gorszą jakością życia po udarze, szczególnie w domenach funkcjonowania fizycznego i wzrokowego, którzy mogliby skorzystać z bardziej ukierunkowanych strategii leczenia i rehabilitacji. ¹⁷

Przewidywanie ryzyka demencji

Prosty wskaźnik choroby małych naczyń (SVD), który wykorzystuje informacje dostępne w szybkiej ocenie wzrokowej klinicznych skanów MRI, może przewidywać ryzyko pogorszenia funkcji poznawczych i demencji, ponad to, co zapewniają proste miary kliniczne. ¹⁸ W zbiorczej analizie trzech kohort, wskaźnik poprawił przewidywanie demencji (pole pod krzywą [AUC], 0,85; 95% CI, 0,81-0,89) w porównaniu z tym, co wynikało z samych klinicznych czynników ryzyka (AUC, 0,76; 95% CI, 0,71-0,81). ¹⁹

Prosty wynik SVD, łatwy do uzyskania z klinicznych skanów MRI, a zatem możliwy do zastosowania w rutynowej praktyce klinicznej, pomógł w przewidywaniu przyszłego ryzyka demencji. ²⁰ Wynik ten poprawił przewidywanie demencji (AUC, 0,85; 95% CI, 0,81-0,89) w porównaniu z samymi czynnikami ryzyka klinicznego (AUC, 0,76; 95% CI, 0,71-0,81), a bardziej nasilone SVD było związane z wyższą wydajnością predykcyjną. ²¹

Implikacją kliniczną jest to, że wynik MRI będzie najbardziej przydatny u pacjentów, którzy już mają znaczące SVD, choć biorąc pod uwagę związek między WMH a chorobą Alzheimera, interesujące byłoby formalne przetestowanie jego wartości predykcyjnej w tej populacji. ²²

Rola nowych technik obrazowania w prognozowaniu

Badania follow-up, takie jak RUN DMC, mają potencjał do dalszego wyjaśnienia przyczyn i ewentualnie lepszego przewidywania konsekwencji zmian integralności istoty białej u osób starszych z SVD poprzez wykorzystanie stosunkowo nowych technik obrazowania. ²³ Dane z takich badań mogą dostarczyć lepszego zrozumienia patofizjologii zaburzeń poznawczych i ruchowych u osób starszych z SVD. ²⁴

Wykonanie i zakończenie follow-up w badaniach może ostatecznie wyjaśnić rolę SVD na mikrostrukturalną integralność istoty białej w przejściu od „normalnego” starzenia się do pogorszenia funkcji poznawczych i ruchowych, a ostatecznie do demencji i parkinsonizmu. ²⁵

Badanie RUN DMC ma potencjał do dalszego wyjaśnienia przyczyn i konsekwencji zmian integralności istoty białej u osób starszych z mózgową SVD poprzez wykorzystanie nowych technik obrazowania, takich jak obrazowanie tensora dyfuzji (DTI) i funkcjonalny rezonans magnetyczny w stanie spoczynku (resting state fMRI). ²⁶ Gdy zostanie to potwierdzone, zmiany w integralności istoty białej ocenione przez te techniki mogą funkcjonować jako zastępczy punkt końcowy dla funkcji poznawczych i ruchowych w przyszłych badaniach terapeutycznych dotyczących naczyniowych czynników ryzyka w SVD. ²⁷

Implikacje dla badań klinicznych

Badania kliniczne u pacjentów ze wszystkimi podtypami cSVD są pilnie potrzebne i powinny stosować szerokie kryteria włączenia i wyniki kliniczne oraz koncentrować się na sposobach maksymalizacji zbierania wyników poznawczych, aby uniknąć brakujących danych. ²⁸ Długoterminowy charakter cSVD wymaga długiego czasu trwania badania, co czyni retencję pacjentów kluczową kwestią. ²⁹

Badanie LACI-2 wykazało, że badania średniej wielkości u pacjentów z cSVD, które wykorzystują wyniki kliniczne, mogą dostarczyć dowodów na korzyści z leczenia. ³⁰ LACI-2 również potwierdziło, że upośledzenie funkcji poznawczych jest najczęstszym niekorzystnym wynikiem po lakunarnym udarze niedokrwiennym, kilkakrotnie częstszym niż nawracający udar, śmierć lub zależność. ³¹

Przyszłe badania u pacjentów z cSVD powinny rozważyć skupienie się na wynikach poznawczych, z zależnością, nawracającymi zdarzeniami naczyniowymi, śmiercią i jakością życia jako wynikami drugorzędowymi. ³²

Rola CSVD w kontekscie leczenia endowaskularnego

Korelacja między chorobą małych naczyń mózgowych (CSVD) a wynikami pacjentów z ostrym udarem niedokrwiennym (AIS) po terapii endowaskularnej (EVT) pozostaje niejasna. ³³ Ostatnie badania wykazały, że CSVD występuje częściej u pacjentów z AIS niż w populacji ogólnej, a ciężkie obciążenie CSVD jest związane ze zwiększonym ryzykiem objawowego krwotoku śródmózgowego (sICH) i złego wyniku u pacjentów z AIS po dożylnej trombolizie (IVT), co jest uważane za czynnik ryzyka dla pacjentów z AIS. ³⁴

Jednak ciężkie obciążenie CSVD nie było istotnie związane z wynikami pierwotnymi i wtórnymi w jednoczynnikowych lub wieloczynnikowych modelach regresji. ³⁵ Wyniki badań sugerują, że ocena poszerzonych przestrzeni okołonaczyniowych w centrum półowalnym (EPVS-CS) może być klinicznie istotnym wskaźnikiem ryzyka wczesnego pogorszenia neurologicznego (END) u pacjentów z niedrożnością dużych naczyń (LVO-AIS) poddawanych EVT. ³⁶

Ogólnie rzecz biorąc, badania sugerują, że pacjenci z ciężkim obciążeniem CSVD, którzy stanowią znaczną część pacjentów z AIS-LVO, mogliby odnieść korzyści z EVT, chociaż deficyty neurologiczne mogą się wahać w fazie nadostrej. ³⁷ W konsekwencji, gdy rozważa się hiperintensywności istoty białej (WMH) i poszerzone przestrzenie okołonaczyniowe (EPVS) razem jako radiologiczne wyrażenie obciążenia CSVD, nie powinny one być wskaźnikiem wykluczającym przy ustalaniu kwalifikacji pacjenta do EVT. ³⁸

Czynniki wpływające na prognozę

Do dnia dzisiejszego prognozowanie, którzy pacjenci z CSVD będą postępować do demencji, okazało się trudne; jednak nowo opracowane biomarkery MRI wykazują obiecujące wyniki. ³⁹ Typowa dysfunkcja chodu obserwowana w CSVD nie powinna być mylona z chodem naczyniowym parkinsonowskim. ⁴⁰

Najbardziej kontrowersyjną populacją w dylemacie zakrzepica-krwawienie są pacjenci z mikrokrwawieniami mózgowymi (CMBs), szczególnie populacja z mózgową angiopatią amyloidową (CAA) z wyłącznie CMBs. ⁴¹ Dodatkowo, obecność amyloidu beta (Aβ) została powiązana z chorobą Alzheimera, a CAA typu kapilarnego może przyczyniać się do demencji u pacjentów z chorobą Alzheimera. ⁴²

Dzięki rosnącej dostępności obrazowania tensora dyfuzji (DTI), skanowania zależnego od poziomu tlenu we krwi (blood oxygen level-dependent), obrazowania ściany naczyń (VWI) i MRI o ultra-wysokim polu, CSVD może być diagnozowane wcześniej, otwierając możliwość odwrócenia procesu chorobowego we wczesnych stadiach. ⁴³

Badania wykazały również nieoczekiwany związek między średnim ciśnieniem rozkurczowym w ciągu 72 godzin (DBP72h) a wynikiem funkcjonalnym przy wypisie i 12 miesięcy później. ⁴⁴ Wyniki sugerują zindywidualizowaną opiekę udarową poprzez obniżanie lub podwyższanie DBP w zależności od obciążenia cSVD w celu wpływu na wynik funkcjonalny. ⁴⁵

Najważniejszym modyfikowalnym czynnikiem ryzyka jest nadciśnienie tętnicze, definiowane jako ciśnienie krwi powyżej 140/90 mm Hg. ⁴⁶ Hiperintensywności istoty białej (WMH) i lakunowe ogniska niedokrwienne były niezależnie związane z ogólną funkcją poznawczą i silnie przewidywały szybkie globalne pogorszenie funkcjonalne w próbce niezależnie żyjących osób starszych (średni wiek 74,1 lat). ⁴⁷

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Materiały źródłowe

#1 CNS small vessel disease
https://pmc.ncbi.nlm.nih.gov/articles/PMC6598791/
CNS small vessel disease (CSVD) causes 25% of strokes and contributes to 45% of dementia cases. […] The prevalence of CSVD increases with age, with no significant sex differences and no currently known differences across racial-ethnic groups or geography. […] The most important modifiable risk factor is arterial hypertension, defined here as blood pressure greater than 140/90 mm Hg. […] WMH and lacunes were independently associated with general cognitive function and strongly predictive of rapid global functional decline in a sample of independently living older persons (mean age, 74.1 years). […] To date, prognosticating which patients with CSVD will progress to dementia has proven difficult; however, newly developed MRI biomarkers show promise. […] The typical gait dysfunction seen in CSVD should not be confused with vascular parkinsonian gait.
#2 Cerebral Small Vessel Disease and Functional Outcome Prediction After Intracerebral Hemorrhage – PubMed
https://pubmed.ncbi.nlm.nih.gov/33627495/
Objective: To determine whether CT-based cerebral small vessel disease (SVD) biomarkers are associated with 6-month functional outcome after intracerebral hemorrhage (ICH) and whether these biomarkers improve the performance of the preexisting ICH prediction score. […] Results: In multivariable models (adjusted for ICH score components), WMH presence (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.12-2.06), cortical atrophy presence (OR 1.80, 95% CI 1.19-2.73), deep atrophy presence (OR 1.66, 95% CI 1.17-2.34), and severe atrophy (either deep or cortical) (OR 1.94, 95% CI 1.36-2.74) were independently associated with poor functional outcome. […] Conclusions: The ICH score has acceptable discrimination for predicting 6-month functional outcome after ICH. CT biomarkers of SVD are associated with functional outcome, but adding them does not significantly improve ICH score discrimination.
#3 Cerebral Small Vessel Disease and Functional Outcome Prediction After Intracerebral Hemorrhage – PubMed
https://pubmed.ncbi.nlm.nih.gov/33627495/
Objective: To determine whether CT-based cerebral small vessel disease (SVD) biomarkers are associated with 6-month functional outcome after intracerebral hemorrhage (ICH) and whether these biomarkers improve the performance of the preexisting ICH prediction score. […] Results: In multivariable models (adjusted for ICH score components), WMH presence (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.12-2.06), cortical atrophy presence (OR 1.80, 95% CI 1.19-2.73), deep atrophy presence (OR 1.66, 95% CI 1.17-2.34), and severe atrophy (either deep or cortical) (OR 1.94, 95% CI 1.36-2.74) were independently associated with poor functional outcome. […] Conclusions: The ICH score has acceptable discrimination for predicting 6-month functional outcome after ICH. CT biomarkers of SVD are associated with functional outcome, but adding them does not significantly improve ICH score discrimination.
#4 Cerebral small vessel disease modifies outcomes after minimally invasive surgery for intracerebral haemorrhage | Stroke and Vascular Neurology
https://svn.bmj.com/content/9/4/446
Cerebral small vessel disease (CSVD) features may have utility for prognostication and patient selection in clinical trials of minimally invasive surgery (MIS). […] Following successful haematoma reduction by MIS, we found significantly lower odds of poor functional outcome with lower total burden of CSVD in addition to absence of lacunes and severe white matter hyperintensities. […] This study finds evidence that baseline CSVD affects long-term outcomes following successful MIS for ICH. […] In this analysis of clinical trial data, the total burden of CSVD on brain MRI and especially that of severe white matter hyperintensities and lacunes significantly modified the effect of successful MIS on unfavourable outcome. […] The finding that these features modify the effect of successful surgery but not MIS without significant volume reduction or standard non-surgical care is consistent with the importance of maximal haematoma reduction as a prerequisite for good outcome. […] If these findings are confirmed in larger clinical trial populations for MIS, one implication is that the CAA score and particularly findings of lacunes and severe WMHs may portend a significantly lower odds of good functional outcome even with successful surgical evacuation.
#5 Cerebral small vessel disease modifies outcomes after minimally invasive surgery for intracerebral haemorrhage | Stroke and Vascular Neurology
https://svn.bmj.com/content/9/4/446
Cerebral small vessel disease (CSVD) features may have utility for prognostication and patient selection in clinical trials of minimally invasive surgery (MIS). […] Following successful haematoma reduction by MIS, we found significantly lower odds of poor functional outcome with lower total burden of CSVD in addition to absence of lacunes and severe white matter hyperintensities. […] This study finds evidence that baseline CSVD affects long-term outcomes following successful MIS for ICH. […] In this analysis of clinical trial data, the total burden of CSVD on brain MRI and especially that of severe white matter hyperintensities and lacunes significantly modified the effect of successful MIS on unfavourable outcome. […] The finding that these features modify the effect of successful surgery but not MIS without significant volume reduction or standard non-surgical care is consistent with the importance of maximal haematoma reduction as a prerequisite for good outcome. […] If these findings are confirmed in larger clinical trial populations for MIS, one implication is that the CAA score and particularly findings of lacunes and severe WMHs may portend a significantly lower odds of good functional outcome even with successful surgical evacuation.
#6 The analysis of association between single features of small vessel disease and stroke outcome shows the independent impact of the number of microbleeds and presence of lacunes | Scientific Reports
https://www.nature.com/articles/s41598-024-53500-7
The impact of small vessel disease (SVD) on stroke outcome was investigated either separately for its single features in isolation or for SVD sum score measuring a qualitative (binary) assessment of SVD-lesions. […] In model 1 with continuous SVD-features, the number of microbleeds was the only independent predictor of stroke outcome in addition to clinical parameters (OR 1.21; 95% CI 1.071.37). […] In model 2 with the binary SVD assessment, only the presence of lacunes independently improved the prediction of stroke outcome (OR 1.48, 1.11.99). […] Thus, the number of microbleeds evaluated continuously and the presence of lacunes are associated with stroke outcome independent from age, stroke severity, pre-stroke disability and other SVD-features. […] The analysis of model 1 with the continuous assessment of SVD features demonstrated that the number of microbleeds at the time of stroke improved prediction of stroke outcome (p=0.002), whereas other SVD parameters EPVS, WMH, and the number of lacunes did not.
#7 The analysis of association between single features of small vessel disease and stroke outcome shows the independent impact of the number of microbleeds and presence of lacunes | Scientific Reports
https://www.nature.com/articles/s41598-024-53500-7
The impact of small vessel disease (SVD) on stroke outcome was investigated either separately for its single features in isolation or for SVD sum score measuring a qualitative (binary) assessment of SVD-lesions. […] In model 1 with continuous SVD-features, the number of microbleeds was the only independent predictor of stroke outcome in addition to clinical parameters (OR 1.21; 95% CI 1.071.37). […] In model 2 with the binary SVD assessment, only the presence of lacunes independently improved the prediction of stroke outcome (OR 1.48, 1.11.99). […] Thus, the number of microbleeds evaluated continuously and the presence of lacunes are associated with stroke outcome independent from age, stroke severity, pre-stroke disability and other SVD-features. […] The analysis of model 1 with the continuous assessment of SVD features demonstrated that the number of microbleeds at the time of stroke improved prediction of stroke outcome (p=0.002), whereas other SVD parameters EPVS, WMH, and the number of lacunes did not.
#8 The analysis of association between single features of small vessel disease and stroke outcome shows the independent impact of the number of microbleeds and presence of lacunes | Scientific Reports
https://www.nature.com/articles/s41598-024-53500-7
In model 2 with the binary evaluation of SVD features, prediction of stroke outcome was improved by the presence of lacunes (p=0.01). […] The number of microbleeds improved the prediction of stroke outcome, whereas the simple presence or absence of one microbleed (binary model) was not informative for the prediction model. […] The presence of lacunes was associated with worse stroke outcome independent of age, stroke severity, pre-stroke disability and other SVD-features.
#9 The analysis of association between single features of small vessel disease and stroke outcome shows the independent impact of the number of microbleeds and presence of lacunes | Scientific Reports
https://www.nature.com/articles/s41598-024-53500-7
In model 2 with the binary evaluation of SVD features, prediction of stroke outcome was improved by the presence of lacunes (p=0.01). […] The number of microbleeds improved the prediction of stroke outcome, whereas the simple presence or absence of one microbleed (binary model) was not informative for the prediction model. […] The presence of lacunes was associated with worse stroke outcome independent of age, stroke severity, pre-stroke disability and other SVD-features.
#10 Burden of cerebral small vessel disease and changes of diastolic blood pressure affect clinical outcome after acute ischemic stroke | Scientific Reports
https://www.nature.com/articles/s41598-023-49502-6
Elevated and low blood pressure (BP) may lead to poor functional outcome after ischemic stroke, which is conflicting. […] cSVD was a predictor of poor outcome (OR 2.8; p0.001). […] A significant relationship was found between DBP72h, (p0.01), cSVD (p=0.013) and outcome at discharge. […] At 12 months, we found a relationship between outcome and DBP72h (p=0.018) and a statistical tendency regarding cSVD (p=0.08). […] Our results suggest an individualized stroke care by either lowering or elevating DBP depending on cSVD-burden in order to influence functional outcome. […] This prospective study of 423 patients with an AIS or TIA showed that cSVD burden was significantly higher in patients with a poor functional outcome at discharge and 12 months after cerebrovascular event. […] An unexpected finding of the present study was a significant association between mean DBP72h and functional outcome at discharge and 12 months afterwards.
#11 Burden of cerebral small vessel disease and changes of diastolic blood pressure affect clinical outcome after acute ischemic stroke | Scientific Reports
https://www.nature.com/articles/s41598-023-49502-6
Elevated and low blood pressure (BP) may lead to poor functional outcome after ischemic stroke, which is conflicting. […] cSVD was a predictor of poor outcome (OR 2.8; p0.001). […] A significant relationship was found between DBP72h, (p0.01), cSVD (p=0.013) and outcome at discharge. […] At 12 months, we found a relationship between outcome and DBP72h (p=0.018) and a statistical tendency regarding cSVD (p=0.08). […] Our results suggest an individualized stroke care by either lowering or elevating DBP depending on cSVD-burden in order to influence functional outcome. […] This prospective study of 423 patients with an AIS or TIA showed that cSVD burden was significantly higher in patients with a poor functional outcome at discharge and 12 months after cerebrovascular event. […] An unexpected finding of the present study was a significant association between mean DBP72h and functional outcome at discharge and 12 months afterwards.
#12 Burden of cerebral small vessel disease and changes of diastolic blood pressure affect clinical outcome after acute ischemic stroke | Scientific Reports
https://www.nature.com/articles/s41598-023-49502-6
Elevated and low blood pressure (BP) may lead to poor functional outcome after ischemic stroke, which is conflicting. […] cSVD was a predictor of poor outcome (OR 2.8; p0.001). […] A significant relationship was found between DBP72h, (p0.01), cSVD (p=0.013) and outcome at discharge. […] At 12 months, we found a relationship between outcome and DBP72h (p=0.018) and a statistical tendency regarding cSVD (p=0.08). […] Our results suggest an individualized stroke care by either lowering or elevating DBP depending on cSVD-burden in order to influence functional outcome. […] This prospective study of 423 patients with an AIS or TIA showed that cSVD burden was significantly higher in patients with a poor functional outcome at discharge and 12 months after cerebrovascular event. […] An unexpected finding of the present study was a significant association between mean DBP72h and functional outcome at discharge and 12 months afterwards.
#13 Burden of cerebral small vessel disease and changes of diastolic blood pressure affect clinical outcome after acute ischemic stroke | Scientific Reports
https://www.nature.com/articles/s41598-023-49502-6
A growing number of studies suggests that cSVD in patients with AIS is independently associated with poor functional outcome in the short and long term after cerebrovascular event. […] The burden of cSVD did not significantly predict poor outcome at 12 months; nonetheless, there was a statistical trend (OR 1.69; 95%CI 0.943.04; p=0.08).
#14 Burden of cerebral small vessel disease and changes of diastolic blood pressure affect clinical outcome after acute ischemic stroke | Scientific Reports
https://www.nature.com/articles/s41598-023-49502-6
A growing number of studies suggests that cSVD in patients with AIS is independently associated with poor functional outcome in the short and long term after cerebrovascular event. […] The burden of cSVD did not significantly predict poor outcome at 12 months; nonetheless, there was a statistical trend (OR 1.69; 95%CI 0.943.04; p=0.08).
#15 Frontiers | Association of Cerebral Small Vessel Disease Burden and Health-Related Quality of Life after Acute Ischemic Stroke
https://www.frontiersin.org/journals/aging-neuroscience/articles/10.3389/fnagi.2017.00372/full
Objective: Cerebral small vessel disease (SVD) is associated with increased mortality, disability and cognitive decline, depression in stroke survivors. This study examined the association between SVD burden, defined by a combination of SVD markers, and health-related quality of life (HRQoL) in acute ischemic stroke. […] Conclusion: The brainâs SVD burden predicts lower HRQoL, predominantly in domains of mobility and vision at 3 months after acute ischemic stroke. The evaluation of SVD burden could facilitate developing individual treatment strategies. […] The main finding of this study is that SVD burden capturing the total brain damage resulting from SVD was independently and negatively associated with HRQoL, particularly in the mobility and vision domains. […] In conclusion, this study found that SVD burden, a combination of four SVD markers, predicted lower HRQoL, particularly the dimensions of mobility and vision examined at 3 months after acute ischemic stroke. The findings suggest that screening baseline SVD burden might help to identify stroke patients with poor poststroke HRQoL, particularly in the physical and visual functioning domains, who would benefit from more focused treatment and rehabilitation strategies.
#16 Frontiers | Association of Cerebral Small Vessel Disease Burden and Health-Related Quality of Life after Acute Ischemic Stroke
https://www.frontiersin.org/journals/aging-neuroscience/articles/10.3389/fnagi.2017.00372/full
Objective: Cerebral small vessel disease (SVD) is associated with increased mortality, disability and cognitive decline, depression in stroke survivors. This study examined the association between SVD burden, defined by a combination of SVD markers, and health-related quality of life (HRQoL) in acute ischemic stroke. […] Conclusion: The brainâs SVD burden predicts lower HRQoL, predominantly in domains of mobility and vision at 3 months after acute ischemic stroke. The evaluation of SVD burden could facilitate developing individual treatment strategies. […] The main finding of this study is that SVD burden capturing the total brain damage resulting from SVD was independently and negatively associated with HRQoL, particularly in the mobility and vision domains. […] In conclusion, this study found that SVD burden, a combination of four SVD markers, predicted lower HRQoL, particularly the dimensions of mobility and vision examined at 3 months after acute ischemic stroke. The findings suggest that screening baseline SVD burden might help to identify stroke patients with poor poststroke HRQoL, particularly in the physical and visual functioning domains, who would benefit from more focused treatment and rehabilitation strategies.
#17 Frontiers | Association of Cerebral Small Vessel Disease Burden and Health-Related Quality of Life after Acute Ischemic Stroke
https://www.frontiersin.org/journals/aging-neuroscience/articles/10.3389/fnagi.2017.00372/full
Objective: Cerebral small vessel disease (SVD) is associated with increased mortality, disability and cognitive decline, depression in stroke survivors. This study examined the association between SVD burden, defined by a combination of SVD markers, and health-related quality of life (HRQoL) in acute ischemic stroke. […] Conclusion: The brainâs SVD burden predicts lower HRQoL, predominantly in domains of mobility and vision at 3 months after acute ischemic stroke. The evaluation of SVD burden could facilitate developing individual treatment strategies. […] The main finding of this study is that SVD burden capturing the total brain damage resulting from SVD was independently and negatively associated with HRQoL, particularly in the mobility and vision domains. […] In conclusion, this study found that SVD burden, a combination of four SVD markers, predicted lower HRQoL, particularly the dimensions of mobility and vision examined at 3 months after acute ischemic stroke. The findings suggest that screening baseline SVD burden might help to identify stroke patients with poor poststroke HRQoL, particularly in the physical and visual functioning domains, who would benefit from more focused treatment and rehabilitation strategies.
#18 Simple MRI score aids prediction of dementia in cerebral small vessel disease.
https://www.repository.cam.ac.uk/items/ae4241e8-ecd2-4aab-8b90-d087f7056758
OBJECTIVE: To determine whether a simple small vessel disease (SVD) score, which uses information available on rapid visual assessment of clinical MRI scans, predicts risk of cognitive decline and dementia, above that provided by simple clinical measures. […] In a pooled analysis of all 3 cohorts, the score improved prediction of dementia (area under the curve [AUC], 0.85; 95% confidence interval [CI], 0.81-0.89) compared with that from clinical risk factors alone (AUC, 0.76; 95% CI, 0.71-0.81). […] CONCLUSIONS: A simple SVD score, easily obtainable from clinical MRI scans and therefore applicable in routine clinical practice, aided prediction of future dementia risk.
#19 Simple MRI score aids prediction of dementia in cerebral small vessel disease.
https://www.repository.cam.ac.uk/items/ae4241e8-ecd2-4aab-8b90-d087f7056758
OBJECTIVE: To determine whether a simple small vessel disease (SVD) score, which uses information available on rapid visual assessment of clinical MRI scans, predicts risk of cognitive decline and dementia, above that provided by simple clinical measures. […] In a pooled analysis of all 3 cohorts, the score improved prediction of dementia (area under the curve [AUC], 0.85; 95% confidence interval [CI], 0.81-0.89) compared with that from clinical risk factors alone (AUC, 0.76; 95% CI, 0.71-0.81). […] CONCLUSIONS: A simple SVD score, easily obtainable from clinical MRI scans and therefore applicable in routine clinical practice, aided prediction of future dementia risk.
#20 Simple MRI score aids prediction of dementia in cerebral small vessel disease.
https://www.repository.cam.ac.uk/items/ae4241e8-ecd2-4aab-8b90-d087f7056758
OBJECTIVE: To determine whether a simple small vessel disease (SVD) score, which uses information available on rapid visual assessment of clinical MRI scans, predicts risk of cognitive decline and dementia, above that provided by simple clinical measures. […] In a pooled analysis of all 3 cohorts, the score improved prediction of dementia (area under the curve [AUC], 0.85; 95% confidence interval [CI], 0.81-0.89) compared with that from clinical risk factors alone (AUC, 0.76; 95% CI, 0.71-0.81). […] CONCLUSIONS: A simple SVD score, easily obtainable from clinical MRI scans and therefore applicable in routine clinical practice, aided prediction of future dementia risk.
#21 Small Vessel Disease Score Can Improve Dementia Risk Prediction
https://www.neurologylive.com/view/small-vessel-disease-score-can-improve-dementia-risk-prediction
New study data suggest that a simple small vessel disease (SVD) score can aid the prediction of future dementia risk. […] The score improved the prediction of dementia (area under the curve [AUC], 0.85; 95% CI, 0.810.89) compared to clinical risk factors alone (AUC, 0.76; 95% CI, 0.710.81), and more severe SVD was associated with higher predictive performance. […] A clinical implication is that the MRI score will be most useful in patients who already have significant SVD, although in view of the association between WMH and Alzheimer disease it would be interesting to formally test its predictive value in this population. […] The strengths of this study are that we determined whether SVD scores could predict progression to dementia in longitudinal studies, Markus and colleagues concluded. Furthermore, we replicated results across multiple cohorts and included cohorts with differing severities of SVD. This allowed us to determine whether the predictive value differed based on the severity of SVD.
#22 Small Vessel Disease Score Can Improve Dementia Risk Prediction
https://www.neurologylive.com/view/small-vessel-disease-score-can-improve-dementia-risk-prediction
New study data suggest that a simple small vessel disease (SVD) score can aid the prediction of future dementia risk. […] The score improved the prediction of dementia (area under the curve [AUC], 0.85; 95% CI, 0.810.89) compared to clinical risk factors alone (AUC, 0.76; 95% CI, 0.710.81), and more severe SVD was associated with higher predictive performance. […] A clinical implication is that the MRI score will be most useful in patients who already have significant SVD, although in view of the association between WMH and Alzheimer disease it would be interesting to formally test its predictive value in this population. […] The strengths of this study are that we determined whether SVD scores could predict progression to dementia in longitudinal studies, Markus and colleagues concluded. Furthermore, we replicated results across multiple cohorts and included cohorts with differing severities of SVD. This allowed us to determine whether the predictive value differed based on the severity of SVD.
#23 Causes and consequences of cerebral small vessel disease. The RUN DMC study: a prospective cohort study. Study rationale and protocol | BMC Neurology | Full Text
https://bmcneurol.biomedcentral.com/articles/10.1186/1471-2377-11-29
Cerebral small vessel disease (SVD) is a frequent finding on CT and MRI scans of elderly people and is related to vascular risk factors and cognitive and motor impairment, ultimately leading to dementia or parkinsonism in some. […] The follow up of the RUN DMC study has the potential to further unravel the causes and possibly better predict the consequences of changes in white matter integrity in elderly with SVD by using relatively new imaging techniques. […] Our data could furthermore provide a better understanding of the pathophysiology of cognitive and motor disturbances in elderly with SVD. […] The execution and completion of the follow up of our study might ultimately unravel the role of SVD on the microstructural integrity of the white matter in the transition from „normal” aging to cognitive and motor decline and impairment and eventually to incident dementia and parkinsonism.
#24 Causes and consequences of cerebral small vessel disease. The RUN DMC study: a prospective cohort study. Study rationale and protocol | BMC Neurology | Full Text
https://bmcneurol.biomedcentral.com/articles/10.1186/1471-2377-11-29
Cerebral small vessel disease (SVD) is a frequent finding on CT and MRI scans of elderly people and is related to vascular risk factors and cognitive and motor impairment, ultimately leading to dementia or parkinsonism in some. […] The follow up of the RUN DMC study has the potential to further unravel the causes and possibly better predict the consequences of changes in white matter integrity in elderly with SVD by using relatively new imaging techniques. […] Our data could furthermore provide a better understanding of the pathophysiology of cognitive and motor disturbances in elderly with SVD. […] The execution and completion of the follow up of our study might ultimately unravel the role of SVD on the microstructural integrity of the white matter in the transition from „normal” aging to cognitive and motor decline and impairment and eventually to incident dementia and parkinsonism.
#25 Causes and consequences of cerebral small vessel disease. The RUN DMC study: a prospective cohort study. Study rationale and protocol | BMC Neurology | Full Text
https://bmcneurol.biomedcentral.com/articles/10.1186/1471-2377-11-29
Cerebral small vessel disease (SVD) is a frequent finding on CT and MRI scans of elderly people and is related to vascular risk factors and cognitive and motor impairment, ultimately leading to dementia or parkinsonism in some. […] The follow up of the RUN DMC study has the potential to further unravel the causes and possibly better predict the consequences of changes in white matter integrity in elderly with SVD by using relatively new imaging techniques. […] Our data could furthermore provide a better understanding of the pathophysiology of cognitive and motor disturbances in elderly with SVD. […] The execution and completion of the follow up of our study might ultimately unravel the role of SVD on the microstructural integrity of the white matter in the transition from „normal” aging to cognitive and motor decline and impairment and eventually to incident dementia and parkinsonism.
#26 Causes and consequences of cerebral small vessel disease. The RUN DMC study: a prospective cohort study. Study rationale and protocol | BMC Neurology | Full Text
https://bmcneurol.biomedcentral.com/articles/10.1186/1471-2377-11-29
To the best of our knowledge there are no other prospective cohort studies investigating the development of incident dementia and parkinsonism using these novel imaging techniques. […] The RUN DMC study has the potential to further unravel the causes and consequences of changes in white matter integrity in elderly with cerebral SVD by using new imaging techniques, DTI and resting state fMRI. When proven, changes in white matter integrity assessed by these techniques might function as a surrogate endpoint for cognitive and motor function in future therapeutic trials of vascular risk factors in SVD.
#27 Causes and consequences of cerebral small vessel disease. The RUN DMC study: a prospective cohort study. Study rationale and protocol | BMC Neurology | Full Text
https://bmcneurol.biomedcentral.com/articles/10.1186/1471-2377-11-29
To the best of our knowledge there are no other prospective cohort studies investigating the development of incident dementia and parkinsonism using these novel imaging techniques. […] The RUN DMC study has the potential to further unravel the causes and consequences of changes in white matter integrity in elderly with cerebral SVD by using new imaging techniques, DTI and resting state fMRI. When proven, changes in white matter integrity assessed by these techniques might function as a surrogate endpoint for cognitive and motor function in future therapeutic trials of vascular risk factors in SVD.
#28 Design of trials in lacunar stroke and cerebral small vessel disease: review and experience with the LACunar Intervention Trial 2 (LACI-2) | Stroke and Vascular Neurology
https://svn.bmj.com/content/9/6/581
Cerebral small vessel disease (cSVD) causes lacunar stroke (25% of ischaemic strokes), haemorrhage, dementia, physical frailty, or is covert, but has no specific treatment. […] Trials in patients with all cSVD subtypes are urgently needed and should use broad entry criteria and clinical outcomes and focus on ways to maximise collection of cognitive outcomes to avoid missing data. […] The long-term nature of cSVD requires long trial duration making retention a key issue. […] LACI-2 demonstrates that moderate-sized trials in patients with cSVD that use clinical outcomes can provide evidence of treatment benefit. […] LACI-2 also confirmed that cognitive impairment is the most common adverse outcome after lacunar ischaemic stroke, several times more frequent than recurrent stroke, death or dependency. […] Future trials in patients with cSVD should consider focusing on cognitive outcomes, with dependency, recurrent vascular events, death and quality of life as secondary outcomes.
#29 Design of trials in lacunar stroke and cerebral small vessel disease: review and experience with the LACunar Intervention Trial 2 (LACI-2) | Stroke and Vascular Neurology
https://svn.bmj.com/content/9/6/581
Cerebral small vessel disease (cSVD) causes lacunar stroke (25% of ischaemic strokes), haemorrhage, dementia, physical frailty, or is covert, but has no specific treatment. […] Trials in patients with all cSVD subtypes are urgently needed and should use broad entry criteria and clinical outcomes and focus on ways to maximise collection of cognitive outcomes to avoid missing data. […] The long-term nature of cSVD requires long trial duration making retention a key issue. […] LACI-2 demonstrates that moderate-sized trials in patients with cSVD that use clinical outcomes can provide evidence of treatment benefit. […] LACI-2 also confirmed that cognitive impairment is the most common adverse outcome after lacunar ischaemic stroke, several times more frequent than recurrent stroke, death or dependency. […] Future trials in patients with cSVD should consider focusing on cognitive outcomes, with dependency, recurrent vascular events, death and quality of life as secondary outcomes.
#30 Design of trials in lacunar stroke and cerebral small vessel disease: review and experience with the LACunar Intervention Trial 2 (LACI-2) | Stroke and Vascular Neurology
https://svn.bmj.com/content/9/6/581
Cerebral small vessel disease (cSVD) causes lacunar stroke (25% of ischaemic strokes), haemorrhage, dementia, physical frailty, or is covert, but has no specific treatment. […] Trials in patients with all cSVD subtypes are urgently needed and should use broad entry criteria and clinical outcomes and focus on ways to maximise collection of cognitive outcomes to avoid missing data. […] The long-term nature of cSVD requires long trial duration making retention a key issue. […] LACI-2 demonstrates that moderate-sized trials in patients with cSVD that use clinical outcomes can provide evidence of treatment benefit. […] LACI-2 also confirmed that cognitive impairment is the most common adverse outcome after lacunar ischaemic stroke, several times more frequent than recurrent stroke, death or dependency. […] Future trials in patients with cSVD should consider focusing on cognitive outcomes, with dependency, recurrent vascular events, death and quality of life as secondary outcomes.
#31 Design of trials in lacunar stroke and cerebral small vessel disease: review and experience with the LACunar Intervention Trial 2 (LACI-2) | Stroke and Vascular Neurology
https://svn.bmj.com/content/9/6/581
Cerebral small vessel disease (cSVD) causes lacunar stroke (25% of ischaemic strokes), haemorrhage, dementia, physical frailty, or is covert, but has no specific treatment. […] Trials in patients with all cSVD subtypes are urgently needed and should use broad entry criteria and clinical outcomes and focus on ways to maximise collection of cognitive outcomes to avoid missing data. […] The long-term nature of cSVD requires long trial duration making retention a key issue. […] LACI-2 demonstrates that moderate-sized trials in patients with cSVD that use clinical outcomes can provide evidence of treatment benefit. […] LACI-2 also confirmed that cognitive impairment is the most common adverse outcome after lacunar ischaemic stroke, several times more frequent than recurrent stroke, death or dependency. […] Future trials in patients with cSVD should consider focusing on cognitive outcomes, with dependency, recurrent vascular events, death and quality of life as secondary outcomes.
#32 Design of trials in lacunar stroke and cerebral small vessel disease: review and experience with the LACunar Intervention Trial 2 (LACI-2) | Stroke and Vascular Neurology
https://svn.bmj.com/content/9/6/581
Cerebral small vessel disease (cSVD) causes lacunar stroke (25% of ischaemic strokes), haemorrhage, dementia, physical frailty, or is covert, but has no specific treatment. […] Trials in patients with all cSVD subtypes are urgently needed and should use broad entry criteria and clinical outcomes and focus on ways to maximise collection of cognitive outcomes to avoid missing data. […] The long-term nature of cSVD requires long trial duration making retention a key issue. […] LACI-2 demonstrates that moderate-sized trials in patients with cSVD that use clinical outcomes can provide evidence of treatment benefit. […] LACI-2 also confirmed that cognitive impairment is the most common adverse outcome after lacunar ischaemic stroke, several times more frequent than recurrent stroke, death or dependency. […] Future trials in patients with cSVD should consider focusing on cognitive outcomes, with dependency, recurrent vascular events, death and quality of life as secondary outcomes.
#33 Cerebral Small Vessel Diseases and Outcomes for Acute Ischemic Stroke Patients after Endovascular Therapy
https://www.mdpi.com/2077-0383/11/23/6883
The correlation between cerebral small vessel disease (CSVD) and the outcomes of acute ischemic stroke (AIS) patients after endovascular therapy (EVT) remains elusive. […] Recent studies have shown that CSVD is more prevalent in AIS patients than it is in general people, and a severe CSVD burden is associated with an increased risk of sICH and poor outcome in AIS patients after intravenous thrombolysis (IVT), which is considered a risk factor for AIS patients. […] A severe CSVD burden was not significantly associated with primary and secondary outcomes in univariate or multivariate regression models. […] Our results suggest that EPVS-CS may be a clinically significant measure of END risk in LVO-AIS patients with EVT. […] Overall, this study suggests that patients with a severe CSVD burden, who constitute a considerable proportion of AIS-LVO patients, would benefit from EVT, although neurologic deficits can fluctuate in the hyperacute stage.
#34 Cerebral Small Vessel Diseases and Outcomes for Acute Ischemic Stroke Patients after Endovascular Therapy
https://www.mdpi.com/2077-0383/11/23/6883
The correlation between cerebral small vessel disease (CSVD) and the outcomes of acute ischemic stroke (AIS) patients after endovascular therapy (EVT) remains elusive. […] Recent studies have shown that CSVD is more prevalent in AIS patients than it is in general people, and a severe CSVD burden is associated with an increased risk of sICH and poor outcome in AIS patients after intravenous thrombolysis (IVT), which is considered a risk factor for AIS patients. […] A severe CSVD burden was not significantly associated with primary and secondary outcomes in univariate or multivariate regression models. […] Our results suggest that EPVS-CS may be a clinically significant measure of END risk in LVO-AIS patients with EVT. […] Overall, this study suggests that patients with a severe CSVD burden, who constitute a considerable proportion of AIS-LVO patients, would benefit from EVT, although neurologic deficits can fluctuate in the hyperacute stage.
#35 Cerebral Small Vessel Diseases and Outcomes for Acute Ischemic Stroke Patients after Endovascular Therapy
https://www.mdpi.com/2077-0383/11/23/6883
The correlation between cerebral small vessel disease (CSVD) and the outcomes of acute ischemic stroke (AIS) patients after endovascular therapy (EVT) remains elusive. […] Recent studies have shown that CSVD is more prevalent in AIS patients than it is in general people, and a severe CSVD burden is associated with an increased risk of sICH and poor outcome in AIS patients after intravenous thrombolysis (IVT), which is considered a risk factor for AIS patients. […] A severe CSVD burden was not significantly associated with primary and secondary outcomes in univariate or multivariate regression models. […] Our results suggest that EPVS-CS may be a clinically significant measure of END risk in LVO-AIS patients with EVT. […] Overall, this study suggests that patients with a severe CSVD burden, who constitute a considerable proportion of AIS-LVO patients, would benefit from EVT, although neurologic deficits can fluctuate in the hyperacute stage.
#36 Cerebral Small Vessel Diseases and Outcomes for Acute Ischemic Stroke Patients after Endovascular Therapy
https://www.mdpi.com/2077-0383/11/23/6883
The correlation between cerebral small vessel disease (CSVD) and the outcomes of acute ischemic stroke (AIS) patients after endovascular therapy (EVT) remains elusive. […] Recent studies have shown that CSVD is more prevalent in AIS patients than it is in general people, and a severe CSVD burden is associated with an increased risk of sICH and poor outcome in AIS patients after intravenous thrombolysis (IVT), which is considered a risk factor for AIS patients. […] A severe CSVD burden was not significantly associated with primary and secondary outcomes in univariate or multivariate regression models. […] Our results suggest that EPVS-CS may be a clinically significant measure of END risk in LVO-AIS patients with EVT. […] Overall, this study suggests that patients with a severe CSVD burden, who constitute a considerable proportion of AIS-LVO patients, would benefit from EVT, although neurologic deficits can fluctuate in the hyperacute stage.
#37 Cerebral Small Vessel Diseases and Outcomes for Acute Ischemic Stroke Patients after Endovascular Therapy
https://www.mdpi.com/2077-0383/11/23/6883
The correlation between cerebral small vessel disease (CSVD) and the outcomes of acute ischemic stroke (AIS) patients after endovascular therapy (EVT) remains elusive. […] Recent studies have shown that CSVD is more prevalent in AIS patients than it is in general people, and a severe CSVD burden is associated with an increased risk of sICH and poor outcome in AIS patients after intravenous thrombolysis (IVT), which is considered a risk factor for AIS patients. […] A severe CSVD burden was not significantly associated with primary and secondary outcomes in univariate or multivariate regression models. […] Our results suggest that EPVS-CS may be a clinically significant measure of END risk in LVO-AIS patients with EVT. […] Overall, this study suggests that patients with a severe CSVD burden, who constitute a considerable proportion of AIS-LVO patients, would benefit from EVT, although neurologic deficits can fluctuate in the hyperacute stage.
#38 Cerebral Small Vessel Diseases and Outcomes for Acute Ischemic Stroke Patients after Endovascular Therapy
https://www.mdpi.com/2077-0383/11/23/6883
Consequently, in our study, when considering WMH and EPVS together as radiological expressions of CSVD burden, it should not be an exclusion indicator when establishing patient eligibility for EVT. Further studies are warranted to clarify the relationship between CSVD burden and the occurrence, progression, and prognosis of AIS.
#39 CNS small vessel disease
https://pmc.ncbi.nlm.nih.gov/articles/PMC6598791/
CNS small vessel disease (CSVD) causes 25% of strokes and contributes to 45% of dementia cases. […] The prevalence of CSVD increases with age, with no significant sex differences and no currently known differences across racial-ethnic groups or geography. […] The most important modifiable risk factor is arterial hypertension, defined here as blood pressure greater than 140/90 mm Hg. […] WMH and lacunes were independently associated with general cognitive function and strongly predictive of rapid global functional decline in a sample of independently living older persons (mean age, 74.1 years). […] To date, prognosticating which patients with CSVD will progress to dementia has proven difficult; however, newly developed MRI biomarkers show promise. […] The typical gait dysfunction seen in CSVD should not be confused with vascular parkinsonian gait.
#40 CNS small vessel disease
https://pmc.ncbi.nlm.nih.gov/articles/PMC6598791/
CNS small vessel disease (CSVD) causes 25% of strokes and contributes to 45% of dementia cases. […] The prevalence of CSVD increases with age, with no significant sex differences and no currently known differences across racial-ethnic groups or geography. […] The most important modifiable risk factor is arterial hypertension, defined here as blood pressure greater than 140/90 mm Hg. […] WMH and lacunes were independently associated with general cognitive function and strongly predictive of rapid global functional decline in a sample of independently living older persons (mean age, 74.1 years). […] To date, prognosticating which patients with CSVD will progress to dementia has proven difficult; however, newly developed MRI biomarkers show promise. […] The typical gait dysfunction seen in CSVD should not be confused with vascular parkinsonian gait.
#41 CNS small vessel disease
https://pmc.ncbi.nlm.nih.gov/articles/PMC6598791/
The most controversial population in the thrombosis-bleeding dilemma is patients with CMBs, especially the CAA population with solely CMBs. […] In addition, the presence of A has been associated with Alzheimer disease, and capillary-type CAA is thought to contribute to dementia among patients with Alzheimer disease. […] With the increasing availability of DTI, blood oxygen level-dependent scanning, VWI, and ultra-high-field MRI, CSVD can be diagnosed earlier, opening the possibility for a reversal in the earliest stages.
#42 CNS small vessel disease
https://pmc.ncbi.nlm.nih.gov/articles/PMC6598791/
The most controversial population in the thrombosis-bleeding dilemma is patients with CMBs, especially the CAA population with solely CMBs. […] In addition, the presence of A has been associated with Alzheimer disease, and capillary-type CAA is thought to contribute to dementia among patients with Alzheimer disease. […] With the increasing availability of DTI, blood oxygen level-dependent scanning, VWI, and ultra-high-field MRI, CSVD can be diagnosed earlier, opening the possibility for a reversal in the earliest stages.
#43 CNS small vessel disease
https://pmc.ncbi.nlm.nih.gov/articles/PMC6598791/
The most controversial population in the thrombosis-bleeding dilemma is patients with CMBs, especially the CAA population with solely CMBs. […] In addition, the presence of A has been associated with Alzheimer disease, and capillary-type CAA is thought to contribute to dementia among patients with Alzheimer disease. […] With the increasing availability of DTI, blood oxygen level-dependent scanning, VWI, and ultra-high-field MRI, CSVD can be diagnosed earlier, opening the possibility for a reversal in the earliest stages.
#44 Burden of cerebral small vessel disease and changes of diastolic blood pressure affect clinical outcome after acute ischemic stroke | Scientific Reports
https://www.nature.com/articles/s41598-023-49502-6
Elevated and low blood pressure (BP) may lead to poor functional outcome after ischemic stroke, which is conflicting. […] cSVD was a predictor of poor outcome (OR 2.8; p0.001). […] A significant relationship was found between DBP72h, (p0.01), cSVD (p=0.013) and outcome at discharge. […] At 12 months, we found a relationship between outcome and DBP72h (p=0.018) and a statistical tendency regarding cSVD (p=0.08). […] Our results suggest an individualized stroke care by either lowering or elevating DBP depending on cSVD-burden in order to influence functional outcome. […] This prospective study of 423 patients with an AIS or TIA showed that cSVD burden was significantly higher in patients with a poor functional outcome at discharge and 12 months after cerebrovascular event. […] An unexpected finding of the present study was a significant association between mean DBP72h and functional outcome at discharge and 12 months afterwards.
#45 Burden of cerebral small vessel disease and changes of diastolic blood pressure affect clinical outcome after acute ischemic stroke | Scientific Reports
https://www.nature.com/articles/s41598-023-49502-6
Elevated and low blood pressure (BP) may lead to poor functional outcome after ischemic stroke, which is conflicting. […] cSVD was a predictor of poor outcome (OR 2.8; p0.001). […] A significant relationship was found between DBP72h, (p0.01), cSVD (p=0.013) and outcome at discharge. […] At 12 months, we found a relationship between outcome and DBP72h (p=0.018) and a statistical tendency regarding cSVD (p=0.08). […] Our results suggest an individualized stroke care by either lowering or elevating DBP depending on cSVD-burden in order to influence functional outcome. […] This prospective study of 423 patients with an AIS or TIA showed that cSVD burden was significantly higher in patients with a poor functional outcome at discharge and 12 months after cerebrovascular event. […] An unexpected finding of the present study was a significant association between mean DBP72h and functional outcome at discharge and 12 months afterwards.
#46 CNS small vessel disease
https://pmc.ncbi.nlm.nih.gov/articles/PMC6598791/
CNS small vessel disease (CSVD) causes 25% of strokes and contributes to 45% of dementia cases. […] The prevalence of CSVD increases with age, with no significant sex differences and no currently known differences across racial-ethnic groups or geography. […] The most important modifiable risk factor is arterial hypertension, defined here as blood pressure greater than 140/90 mm Hg. […] WMH and lacunes were independently associated with general cognitive function and strongly predictive of rapid global functional decline in a sample of independently living older persons (mean age, 74.1 years). […] To date, prognosticating which patients with CSVD will progress to dementia has proven difficult; however, newly developed MRI biomarkers show promise. […] The typical gait dysfunction seen in CSVD should not be confused with vascular parkinsonian gait.
#47 CNS small vessel disease
https://pmc.ncbi.nlm.nih.gov/articles/PMC6598791/
CNS small vessel disease (CSVD) causes 25% of strokes and contributes to 45% of dementia cases. […] The prevalence of CSVD increases with age, with no significant sex differences and no currently known differences across racial-ethnic groups or geography. […] The most important modifiable risk factor is arterial hypertension, defined here as blood pressure greater than 140/90 mm Hg. […] WMH and lacunes were independently associated with general cognitive function and strongly predictive of rapid global functional decline in a sample of independently living older persons (mean age, 74.1 years). […] To date, prognosticating which patients with CSVD will progress to dementia has proven difficult; however, newly developed MRI biomarkers show promise. […] The typical gait dysfunction seen in CSVD should not be confused with vascular parkinsonian gait.