Total small vessel disease score and risk of recurrent stroke: Validation in 2 large cohorts

Kui Kai Lau, Linxin Li, Ursula Schulz, Michela Simoni, Koon Ho Chan, Shu Leong Ho, Raymond Tak Fai Cheung, Wilhelm Küker, Henry Ka Fung Mak, Peter M Rothwell, Kui Kai Lau, Linxin Li, Ursula Schulz, Michela Simoni, Koon Ho Chan, Shu Leong Ho, Raymond Tak Fai Cheung, Wilhelm Küker, Henry Ka Fung Mak, Peter M Rothwell

Abstract

Objective: In patients with TIA and ischemic stroke, we validated the total small vessel disease (SVD) score by determining its prognostic value for recurrent stroke.

Methods: Two independent prospective studies were conducted, one comprising predominantly Caucasian patients with TIA/ischemic stroke (Oxford Vascular Study [OXVASC]) and one predominantly Chinese patients with ischemic stroke (University of Hong Kong [HKU]). Cerebral MRI was performed and assessed for lacunes, microbleeds, white matter hyperintensities (WMH), and perivascular spaces (PVS). Predictive value of total SVD score for risk of recurrent stroke was determined and potential refinements considered.

Results: In 2,002 patients with TIA/ischemic stroke (OXVASC n = 1,028, HKU n = 974, 6,924 patient-years follow-up), a higher score was associated with an increased risk of recurrent ischemic stroke (adjusted hazard ratio [HR] per unit increase: 1.32, 1.16-1.51, p < 0.0001; c statistic 0.61, 0.56-0.65, p < 0.0001) and intracerebral hemorrhage (ICH) (HR 1.54, 1.11-2.13, p = 0.009; c statistic 0.65, 0.54-0.76, p = 0.006). A higher score predicted recurrent stroke in SVD and non-SVD TIA/ischemic stroke subtypes (c statistic 0.67, 0.59-0.74, p < 0.0001 and 0.60, 0.55-0.65, p < 0.0001). Including burden of microbleeds and WMH and adjusting the cutoff of basal ganglia PVS potentially improved predictive power for ICH (c statistic 0.71, 0.60-0.81, phet = 0.45), but not for recurrent ischemic stroke (c statistic 0.60, 0.56-0.65, phet = 0.76) on internal validation.

Conclusions: The total SVD score has predictive value for recurrent stroke after TIA/ischemic stroke. Prediction of recurrence in patients with nonlacunar events highlights the potential role of SVD in wider stroke etiology.

Copyright © 2017 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

Figures

Figure. Risk of recurrent stroke, recurrent ischemic…
Figure. Risk of recurrent stroke, recurrent ischemic stroke, and intracerebral hemorrhage with increasing burden of small vessel disease
Risk of (A) recurrent stroke, (B) recurrent ischemic stroke, and (C) intracerebral hemorrhage with increasing burden of small vessel disease. Hazard ratios adjusted for age, sex, vascular risk factors, and center and compared with patients with

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