Cerebral small vessel disease and its impact on the course and outcome of stroke


  • R. S. Bartiuk National Pirogov Memorial Medical University, Vinnytsya, Ukraine
Keywords: cerebral small vessel disease, stroke, leukoaraiosis, lacunes, CT.

Abstract

Cerebral small vessel disease (CSVD) is a common cause of stroke (25 % of all strokes) and has a significant contribution to development dementia, functional loss and increases the risk of death. Validation of methods for assessing the total cerebral small vessel disease burden on CT and MRI makes it possible to more accurately and fully assess the impact of the cumulative effect of cerebrovascular pathology on the development and consequences of stroke after 3 months. The aim of our study was to investigate the prognostic value of the total CSVD burden and its individual features (leukoaraiosis, lacunes, brain atrophy) on the course and outcome of stroke at 90 days. 131 patients with ischemic stroke, diagnosed according to TOAST criteria, were enrolled. All patients underwent computed tomography on a General Electric CT/e device (Italy) with a slice thickness of 3–7 mm. Leukoaraiosis was diagnosed and scored by the visual scale of Fazekas and von Swieten. Brain atrophy was assessed separately in central and cortical regions by validated standard template. Lacunes were defined according to the standard protocol. We calculated the total CSVD burden (composed leukoaraiosis, lacunes, brain atrophy) with and without brain atrophy. We assessed the severity of neurological deficit by the NIHSS scale. The functional outcome and the degree of disability or dependence in the daily activities we measured by modified Rankin scale and Barthel index. MMSE was used to assess cognitive function. Statistical analyses were performed by SPSS 25.0 software (IBM Corp., Armonk, NY, USA). We used Student’s t-test or Mann-Whitney U test, Pearson or Spearman correlation and regression analysis. Our data have shown that cerebral small vessel disease is negatively correlated with the consequences of stroke and reflect brain frailty and impair regenerative potential. The degree of cognitive deficit was associated with negative prognostic consequences of stroke. The total cerebral small vessel disease burden is a valuable prognostic marker of stroke prognosis and can be used as a tool for the assessment of effectiveness of preventive and curative measures.

References

[1] Appleton, J. P., Woodhouse, L. J., Adami, A., Becker, J. L., Berge, E., Cala, L. A., ... Wardlaw, J. M. (2020). Imaging markers of small vessel disease and brain frailty, and outcomes in acute stroke. Neurology, 94(5), e439-e452. doi: 10.1212/WNL.0000000000008881

[2] Arba, F., Palumbo, V., Boulanger, J. M., Pracucci, G., Inzitari, D., Buchan, A. M., ... & Hill, M. D. (2016). Leukoaraiosis and lacunes are associated with poor clinical outcomes in ischemic stroke patients treated with intravenous thrombolysis. International journal of stroke: official journal of the International Stroke Society, 11(1), 62-67. doi: 10.1177/1747493015607517

[3] Benjamin, P., Zeestraten, E., Lambert, C., Ster, I. C., Williams, O. A., Lawrence, A. J., ... & Markus, H. S. (2016). Progression of MRI markers in cerebral small vessel disease: Sample size considerations for clinical trials. Journal of cerebral blood flow and metabolism: official journal of the International Society of Cerebral Blood Flow and Metabolism, 36(1), 228-240. doi: 10.1038/jcbfm.2015.113

[4] Caruso, P., Signori, R., & Moretti, R. (2019). Small vessel disease to subcortical dementia: a dynamic model, which interfaces aging, cholinergic dysregulation and the neurovascular unit. Vascular health and risk management, 15, 259-281. doi: 10.2147/VHRM.S190470

[5] Chen, X., Wang, J., Shan, Y., Cai, W., Liu, S., Hu, M., ... & Lu, Z. (2019). Cerebral small vessel disease: neuroimaging markers and clinical implication. Journal of neurology, 266(10), 2347-2362. doi: 10.1007/s00415-018-9077-3

[6] Gökçal, E., Niftaliyev, E., & Asil, T. (2017). Etiological classification of ischemic stroke in young patients: a comparative study of TOAST, CCS, and ASCO. Acta neurologica Belgica, 117(3), 643-648. doi: 10.1007/s13760-017-0813-8

[7] Goldstein, E. D., Badi, M. K., Hasan, T. F., Lesser, E. R., Hodge, D. O., Lin, M. P., & Meschia, J. F. (2019). Cerebral Small Vessel Disease Burden and All-Cause Mortality: Mayo Clinic Florida Familial Cerebrovascular Diseases Registry. Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association, 28(12), 104285. doi: 10.1016/j.jstrokecerebrovasdis.2019.07.001

[8] Huo, Y. C., Li, Q., Zhang, W. Y., Zou, N., Li, R., Huang, S. Y., ... & Qin, X. Y. (2019). Total Small Vessel Disease Burden Predicts Functional Outcome in Patients With Acute Ischemic Stroke. Frontiers in neurology, 10, 808. doi: 10.3389/fneur.2019.00808

[9] Lau, K. K., Li, L., Schulz, U., Simoni, M., Chan, K. H., Ho, S. L., ... & Rothwell, P. M. (2017). Total small vessel disease score and risk of recurrent stroke: Validation in 2 large cohorts. Neurology, 88(24), 2260-2267. doi: 10.1212/WNL.0000000000004042

[10] Li, Q., Yang, Y., Reis, C., Tao, T., Li, W., Li, X., & Zhang, J. H. (2018). Cerebral Small Vessel Disease. Cell transplantation, 27(12), 1711-1722. doi: 10.1177/0963689718795148

[11] Marek, M., Horyniecki, M., Frączek, M., & Kluczewska, E. (2018). Leukoaraiosis - new concepts and modern imaging. Polish journal of radiology, 83, e76-e81. doi: 10.5114/pjr.2018.74344

[12] Mustapha, M., Nassir, C., Aminuddin, N., Safri, A. A., & Ghazali, M. M. (2019). Cerebral Small Vessel Disease (CSVD) - Lessons From the Animal Models. Frontiers in physiology, 10, 1317. doi: 10.3389/fphys.2019.01317

[13] Poggesi, A., Pasi, M., Pescini, F., Pantoni, L., & Inzitari, D. (2016). Circulating biologic markers of endothelial dysfunction in cerebral small vessel disease: A review. Journal of cerebral blood flow and metabolism: official journal of the International Society of Cerebral Blood Flow and Metabolism, 36(1), 72-94. doi: 10.1038/jcbfm.2015.116

[14] Qi, X. M., & Ma, J. F. (2017). The role of amyloid beta clearance in cerebral amyloid angiopathy: more potential therapeutic targets. Translational neurodegeneration, 6, 22. doi: 10.1186/s40035-017-0091-7

[15] Qu, J. F., Chen, Y. K., Zhong, H. H., Li, W., & Lu, Z. H. (2019). Preexisting Cerebral Abnormalities and Functional Outcomes After Acute Ischemic Stroke. Journal of geriatric psychiatry and neurology, 32(6), 327-335. doi: 10.1177/0891988719862631

[16] Sato, S., Delcourt, C., Heeley, E., Arima, H., Zhang, S., Al-Shahi Salman, R., ... & Anderson, C. S. (2016). Significance of Cerebral Small-Vessel Disease in Acute Intracerebral Hemorrhage. Stroke, 47(3), 701-707. doi: 10.1161/STROKEAHA.115.012147

[17] Shu, L., Liang, J., Xun, W., Yang, H., & Lu, T. (2020). Prediction for the Total MRI Burden of Cerebral Small Vessel Disease With Retinal Microvascular Abnormalities in Ischemic Stroke/TIA Patients. Frontiers in neurology, 11, 268. doi: 10.3389/fneur.2020.00268

[18] Sims, J. R., Gharai, L. R., Schaefer, P. W., Vangel, M., Rosenthal, E. S., Lev, M. H., & Schwamm, L. H. (2009). ABC/2 for rapid clinical estimate of infarct, perfusion, and mismatch volumes. Neurology, 72(24), 2104-2110. doi: 10.1212/WNL.0b013e3181aa5329

[19] Song, T. J., Kim, J., Song, D., Yoo, J., Lee, H. S., Kim, Y. J., … & Kim, Y. D. (2017). Total Cerebral Small-Vessel Disease Score is Associated with Mortality during Follow-Up after Acute Ischemic Stroke. Journal of clinical neurology (Seoul, Korea), 13(2), 187-195. doi: 10.3988/jcn.2017.13.2.187

[20] Wardlaw, J. M., Makin, S. J., Valdés Hernández, M. C., Armitage, P. A., Heye, A. K., Chappell, F. M., … & Thrippleton, M. J. (2017). Blood-brain barrier failure as a core mechanism in cerebral small vessel disease and dementia: evidence from a cohort study. Alzheimer's & Dementia, 13(6), 634-643. doi: 10.1016/j.jalz.2016.09.006

[21] Zerna, C., Yu, A., Hong, Z., Penn, A., Lesperance, M., Croteau, N., … & Coutts, S. (2019). White Matter Hyperintensity Volume Influences Symptoms in Patients Presenting With Minor Neurological Deficits, Stroke, 51(2), 409-415. doi: 10.1161/STROKEAHA.117.017429

[22] Zinn, S., Dudley, T. K., Bosworth, H. B., Hoenig, H. M., Duncan, P. W., & Horner, R. D. (2004). The effect of poststroke cognitive impairment on rehabilitation process and functional outcome. Archives of physical medicine and rehabilitation, 85(7), 1084-1090. doi: 10.1016/j.apmr.2003.10.022
Published
2020-07-10
How to Cite
Bartiuk, R. S. (2020). Cerebral small vessel disease and its impact on the course and outcome of stroke. Biomedical and Biosocial Anthropology, (36), 58-63. https://doi.org/https://doi.org/10.31393/bba36-2019-10