title: Association of leukoaraiosis with stroke recurrence within 5 years after initial stroke.
abstract: BACKGROUND
  Leukoaraiosis (LA) is closely associated with stroke. Despite the fact that LA has consistently been shown to predict development of recurrent stroke, prior studies on the association of LA and stroke subtypes have been unsatisfactory. In this study, we sought to identify whether LA contributes to the recurrence of certain subtypes of stroke at long term.
  
  
  METHODS
  Data from the Ege Stroke Registry were examined, and 5 years follow-up data for LA and stroke recurrence were analyzed. We performed survival curves using the Kaplan-Meier method (unadjusted) and log-rank tests in patients with stroke to determine the relationship between LA and recurrent stroke by stroke subtypes within a time period of 5 years. Multivariate survival analyses were undertaken using Cox proportional hazards models to determine the prognostic value of LA, stroke subtypes, and other vascular risk factors before recurrent stroke.
  
  
  RESULTS
  Of 9522 patients with stroke, 1280 (26%) with LA and 901 (19%) without LA experienced a stroke recurrence within 5 years of follow-up (odds ratio, 1.53; 95% confidence interval, 1.39-1.69). After stratification by stroke subtypes, multivariable analysis revealed a significant association between LA and large artery disease (LAD; odds ratio [OR], 1.39; 95% confidence interval [CI], 1.18-1.64), small artery disease (SAD; OR, 1.57; 95% CI, 1.27-1.94), and intracerebral hemorrhage (ICH; OR, 1.88; 95% CI, 1.32-2.66), except cardioembolic stroke and "other" stroke subtypes at 5 years after stroke onset. The survival analysis showed that stroke recurrence was significantly higher in patients with severe LA compared with those with mild/moderate LA (log-rank test [Mantel-Cox], P < .001).
  
  
  CONCLUSIONS
  Our results showed that LA is related to the recurrent strokes in patients with stroke within 5 years after stroke, specifically to the LAD, SAD and ICH.
authors.affiliation: Stroke Unit, Neurology Department, School of Medicine, Ege University, İzmir, Turkey. Electronic address: emre.kumral@ege.edu.tr.
authors.forename: Emre
authors.initials: E
authors.lastname: Kumral
authors.affiliation: Neurology Department, Medical Park Hospital, İzmir University, İzmir, Turkey.
authors.forename: Halil
authors.initials: H
authors.lastname: Güllüoğlu
authors.affiliation: Stroke Unit, Neurology Department, School of Medicine, Ege University, İzmir, Turkey.
authors.forename: Naila
authors.initials: N
authors.lastname: Alakbarova
authors.affiliation: Stroke Unit, Neurology Department, School of Medicine, Ege University, İzmir, Turkey.
authors.forename: Bedriye
authors.initials: B
authors.lastname: Karaman
authors.affiliation: Stroke Unit, Neurology Department, School of Medicine, Ege University, İzmir, Turkey.
authors.forename: Emrah Emre
authors.initials: EE
authors.lastname: Deveci
authors.affiliation: Stroke Unit, Neurology Department, School of Medicine, Ege University, İzmir, Turkey.
authors.forename: Aydın
authors.initials: A
authors.lastname: Bayramov
authors.affiliation: Stroke Unit, Neurology Department, School of Medicine, Ege University, İzmir, Turkey.
authors.forename: Dilek
authors.initials: D
authors.lastname: Evyapan
authors.affiliation: Stroke Unit, Neurology Department, School of Medicine, Ege University, İzmir, Turkey.
authors.forename: Figen
authors.initials: F
authors.lastname: Gökçay
authors.affiliation: Biostatistic Department, School of Medicine, Ege University, İzmir, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Orman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D049292:Leukoaraiosis / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D013997:Time Factors; D014421:Turkey / Q000453:epidemiology
keywords: Leukoaraiosis; large artery disease; small artery disease; stroke recurrence