Coexisting small vessel disease predicts poor long-term outcome in stroke patients with intracranial large artery atherosclerosis.
OBJECTIVE
Until now, limited data are available about the potential effect of coexisting small vessel disease (SVD) on the long-term outcome of stroke patients with intracranial large artery atherosclerosis (ILAA).


METHODS
A prospective study was performed on 293 patients with symptomatic ILAA, who were divided into 4 groups (group I, single intracranial large artery atherosclerosis (SILAA) without SVD; group II, multiple intracranial large arteries atherosclerosis (MILAA) without SVD; group III, SILAA with SVD; group IV, MILAA with SVD) and followed up for recurrent stroke or death.


RESULTS
The 3-year cumulative risks of recurrent stroke were 18% for SILAA without SVD, 38% for MILAA without SVD, 21% for SILAA with SVD and 34% for MILAA with SVD. The 3-year cumulative risks of death were 6, 7, 20 and 22%, respectively. Compared with SILAA without SVD, more recurrent stroke occurred in MILAA without SVD (log-rank 3.83; p = 0.050) and MILAA with SVD (log-rank 7.79; p = 0.014), and the higher risk of death (log-rank 9.472; p = 0.002) was found in group MILAA with SVD. A Cox proportional-hazards regression model showed that MILAA with SVD may be a predictor of recurrent stroke (hazard ratio 2.001; 95% CI 1.108-3.934; p = 0.044), and a borderline predictor for death (hazard ratio 3.180; 95% CI 0.895-10.987; p = 0.073).


CONCLUSIONS
Coexisting SVD is very common and may predict poor outcome in stroke patients with symptomatic ILAA.
Fu
Jian Hui
JH
Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.
Chen
Yang Kun
YK
Chen
Xiang Yan
XY
Mok
Vincent
V
Wong
Ka Sing
KS
D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000098:blood supply*; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000453:epidemiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D055806:Microvessels; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis*; D014652:Vascular Diseases / Q000453:epidemiology*