Clinical Associations and Prognostic Value of MRI-Visible Perivascular Spaces in Patients With Ischemic Stroke or TIA: A Pooled Analysis.
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Best Jonathan G, Ambler Gareth, Wilson Duncan, Du Houwei, Lee Keon-Joo, Lim Jae-Sung, Teo Kay Cheong, Mak Henry, Kim Young Dae, Song Tae-Jin, Selcuk Demirelli Derya, Nishihara Masashi, Yoshikawa Masaaki, Kubacka Marta, Zietz Annaelle, Al-Shahi Salman Rustam, Jäger Hans Rolf, Lip Gregory Y H, Panos Leonidas, Goeldlin Martina B, Slater Lee-Anne, Karayiannis Christopher Charles, Phan Thanh G, Bellut Maximilian, Abrigo Jill, Cheng Cyrus, Leung Thomas W, Chu Winnie, Chappell Francesca, Makin Stephen D J, van Dam-Nolen Dianne H K, Kooi M Eline, Köhler Sebastian, Staals Julie, Kuchcinski Grégory, Bordet Régis, Dubost Florian, Wardlaw Joanna M, Soo Yannie O Y, Fluri Felix, Srikanth Velandai K, Jung Simon, Peters Nils, Hara Hideo, Yakushiji Yusuke, Necioglu Orken Dilek, Heo Ji-Hoe, Lau Gary Kui Kai, Bae Hee-Joon, Werring David J
Аннотация
METHODS: We pooled individual patient data from a consortium of prospective cohort studies. Participants had recent ischemic stroke or transient ischemic attack (TIA), underwent baseline MRI, and were followed up for ischemic stroke and symptomatic intracranial hemorrhage (ICH). Perivascular spaces in the basal ganglia (BGPVS) and perivascular spaces in the centrum semiovale (CSOPVS) were rated locally using a validated visual scale. We investigated clinical and radiologic associations cross-sectionally using multinomial logistic regression and prospective associations with ischemic stroke and ICH using Cox regression.
RESULTS: We included 7,778 participants (mean age 70.6 years; 42.7% female) from 16 studies, followed up for a median of 1.44 years. Eighty ICH and 424 ischemic strokes occurred. BGPVS were associated with increasing age, hypertension, previous ischemic stroke, previous ICH, lacunes, cerebral microbleeds, and white matter hyperintensities. CSOPVS showed consistently weaker associations. Prospectively, after adjusting for potential confounders including cerebral microbleeds, increasing BGPVS burden was independently associated with future ischemic stroke (versus 0-10 BGPVS, 11-20 BGPVS: HR 1.19, 95% CI 0.93-1.53; 21+ BGPVS: HR 1.50, 95% CI 1.10-2.06; p = 0.040). Higher BGPVS burden was associated with increased ICH risk in univariable analysis, but not in adjusted analyses. CSOPVS were not significantly associated with either outcome.
DISCUSSION: In patients with ischemic stroke or TIA, increasing BGPVS burden is associated with more severe cerebral small vessel disease and higher ischemic stroke risk. Neither BGPVS nor CSOPVS were independently associated with future ICH.