title: Extensive leukoaraiosis is associated with high early risk of recurrence after ischemic stroke.
abstract: OBJECTIVE
  The integrity of white matter tracts connecting different parts of the brain is important for rapid compensation for the lost function from ischemic stroke. Impaired white matter reserve capacity secondary to leukoaraiosis may facilitate detection of new symptomatic ischemic events that would otherwise remain inconspicuous after an initial ischemic stroke. We sought to identify whether the extent of leukoaraiosis was a predictor of risk of early stroke recurrence.
  
  
  METHODS
  We used Cox regression analysis in consecutive patients with ischemic stroke to determine the relationship between leukoaraiosis burden and symptomatic stroke recurrence within 90 days. We graded total leukoaraiosis, periventricular leukoaraiosis, and subcortical leukoaraiosis using the Fazekas scale as mild (<2) and extensive (≥2) on fluid-attenuated inversion recovery images obtained within 72 hours of stroke onset in the hemisphere contralateral to acute stroke.
  
  
  RESULTS
  There were 106 recurrent events in 2378 patients. The cumulative incidence of recurrence was 5.9% at 90 days. Kaplan-Meier estimate of recurrence-free survival rate was lower in patients with extensive leukoaraiosis (P=0.04) and extensive periventricular leukoaraiosis (P=0.02) but not in extensive subcortical leukoaraiosis (P=0.09). Multivariable Cox regression analysis revealed a hazard ratio of 1.50 (95% confidence interval, 1.00-2.25) for extensive leukoaraiosis, 1.67 (95% confidence interval, 1.11-2.51) for extensive periventricular leukoaraiosis, and 1.42 (95% confidence interval, 0.94-2.12) for extensive subcortical leukoaraiosis.
  
  
  CONCLUSIONS
  The extent of leukoaraiosis independently predicts 90-day recurrent stroke risk after ischemic stroke. This suggests that leukoaraiosis may be used for risk stratification in ischemic stroke.
authors.affiliation: From the Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (G.-M.K.); Department of Radiology, A.A. Martinos Center for Biomedical Imaging (G.-M.K., K.-Y.P., R.A., J.H., B.R., H.A.) and Department of Neurology, Stroke Service (N.R., J.R., H.A.), Massachusetts General Hospital, Harvard Medical School, Boston; and Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea (K.-Y.P.).
authors.forename: Gyeong-Moon
authors.initials: GM
authors.lastname: Kim
authors.forename: Kwang-Yeol
authors.initials: KY
authors.lastname: Park
authors.forename: Ross
authors.initials: R
authors.lastname: Avery
authors.forename: Johanna
authors.initials: J
authors.lastname: Helenius
authors.forename: Natalia
authors.initials: N
authors.lastname: Rost
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rosand
authors.forename: Bruce
authors.initials: B
authors.lastname: Rosen
authors.forename: Hakan
authors.initials: H
authors.lastname: Ay
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D053208:Kaplan-Meier Estimate; D049292:Leukoaraiosis / Q000150:complications* / Q000453:epidemiology / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000473:pathology; D016019:Survival Analysis
keywords: leukoaraiosis; magnetic resonance imaging; stroke