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Cerebral white matter hypoperfusion increases with small vessel disease burden. Data from the IST-3 trial

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Original languageEnglish
JournalJournal of Stroke and Cerebrovascular Diseases
Early online date15 Mar 2017
Publication statusE-pub ahead of print - 15 Mar 2017


Introduction: Leukoaraiosis is associated with impaired cerebral perfusion but the effect of individual and combined small vessel disease (SVD) features on white matter perfusion is unclear.
Methods: We studied patients recruited with perfusion imaging in the IST-3 trial. We rated individual SVD features (leukoaraiosis, lacunes) and brain atrophy on baseline plain CT or MR imaging. Separately, we assessed white matter at the level of the lateral ventricles in the cerebral hemisphere contralateral to the stroke for visible areas of hypoperfusion (present/absent) on four time-based perfusion imaging parameters. We examined associations between SVD features (individually and summed) and presence of hypoperfusion using logistic regression adjusted for age, sex, baseline NIHSS, hypertension, and diabetes.
Results: 115 patients, median (IQR) age 81 (72-86) years, 78 (52%) males had complete perfusion data. Hypoperfusion was most frequent on mean transit time (MTT; 63 patients, 55%), and least frequent on Tmax (19 patients, 17%). The SVD score showed stronger independent associations with hypoperfusion (e.g. MTT, OR=2.80; 95% CI=1.56-5.03), than individual SVD markers (e.g. white matter hypoattenuation score, MTT, OR 1.49, 95%CI=1.09, 2.04). Baseline BP did not differ by presence/absence of hypoperfusion or across strata of SVD score. Presence of white matter hypoperfusion increased with SVD summed score.
Conclusions: The SVD summed score was associated with hypoperfusion more consistently than individual SVD features, providing validity to the SVD score concept. Increasing SVD burden indicates worse perfusion in the white matter.

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