Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases
In patients who had a stroke or TIA, enlarged perivascular spaces in basal ganglia may cause future haemorrhagic strokes
First author：Yu Tian
Corresponding author：Yilong Wang
essential_information
2023-05-15
Published articles
Journal：
Publication type: Original Contributions
IF(IF): 9.893
PMID: 37188388 Link To Pubmed Full text Download
Background And Purpose
Emerging evidence has highlighted the role of the perivascular space (PVS) as a glymphatic pathway for waste clearance in the brain and demonstrated that glymphatic dysfunction was related to brain edema in patients with acute ischaemic stroke. Hence, we aim to investigate the association between enlarged perivascular spaces and different outcomes in patients with translation ischaemic attack or acute ischaemic stroke to illustrate the potential role of glymphatic system.
Method
PVS was defined on MRI as small, sharply delineated structures of CSF intensity (or close to CSF intensity) following the course of perforating vessels. PVS in the basal ganglia(BG-PVS) and centrum semiovale (CSO-PVS) were rated separately on T2 weighted sequence as 0 = none, 1 = 1–10, 2 = 11–20, 3 = 21–40, and 4 = >40 PVS per side. The associations of EPVS with recurrence of stroke, ischemic stroke, hemorrhage stroke and combined vascular events were investigated with the use of Cox proportional hazards models. Logistic regression model was used to explore the association of EPVS with disability and all-cause death. In sensitivity analysis, in order to investigate to potential role of glymphatic system in cerebral small vessel disease, the associations between EPVS and outcomes also were explored in TIA/AIS patients with CSVD and in TIA/AIS patients with small arteries occlusion.
Conclusion
BG-EPVS increased the risk of haemorrhagic stroke in patients already with AIS/TIA within 1 year. Therefore, caution is recommended when selecting antithrombotic agents for secondary stroke prevention in patients with AIS/TIA and more severe BG-EPVS.
Main results
61.7±11.6 years, and 68.2% were men. After adjusting for all potential confounders, frequent-tosevere BG-EPVS was associated with a decreased risk of recurrent ischaemic stroke (HR 0.71, 95% CI 0.55 to 0.92, p=0.01) but an increased risk of haemorrhagic stroke (HR 1.99, 95% CI 1.11 to 3.58, p=0.02) at 1 year after AIS/ TIA, compared with none-to-mild BG-EPVS. Patients with frequent-to-severe CSO-EPVS had a decreased risk of disability (OR 0.76, 95% CI 0.62 to 0.92, p=0.004) and all-cause death (HR 0.55, 95% CI 0.31 to 0.98, p=0.04) within 3-month but not 1-year follow-ups, compared with those with none-to-mild BG-EPVS. Sensitivity analyses showed that both BG-EPVS (HR 0.43, 95% CI 0.21 to 0.87, p=0.02) and CSO-EPVS (HR 0.58, 95% CI 0.35 to 0.95, p=0.03) were associated with a decreased risk of subsequent ischaemic stroke in patients with SAO during 1-year follow-up.