Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases
White matter lesion volume and ratio is associated with the risk of intracranial hemorrhage and outcome of stroke patients
First author：Yuyuan Xu
Corresponding author：Yongjun Wang
essential_information
2020-03-13
Published articles
Journal：Annals of Translational Medicine
Publication type: Article
IF(IF): 3.932
PMID: 32355775 Link To Pubmed Full text Download
Background And Purpose
Stroke is a leading cause of mortality and disability. Combination antiplatelet therapy with clopidogrel and aspirin could reduce the rate of recurrent stroke during the first 3 months after a minor ischemic stroke or transient ischemic attack (TIA), on the other hand increases the risk of intracerebral hemorrhage at 90 days than aspirin alone. White matter lesions, also known as leukoaraiosis, is defined as a diffuse, confluent white matter abnormality (with a low density on CT and hyperintensity on T2 or FLAIR MR images). It is an established cerebral microangiopathy marker is associated with cognitive impairment, triples the risk of future stroke and doubles the risk of death. Leukoaraiosis has been reported to predispose to intracranial hemorrhage (ICH) related to treatment of warfarin and thrombolysis, commonly located in the basal ganglia and deep cerebral areas. However, the association between ICH and white matter lesion volume and its ratio in dual antiplatelet therapy has rarely been reported yet. In addition, previous studies about white matter lesions are mainly qualitative or semiquantitative analysis, such as Fazekas scores. It might help to accurately stratified the risk of intracranial hemorrhage in second preventive treatment and make precise therapeutic strategy. Objectives/Hypotheses: To investigate the association of ICH with white matter lesion volume and its ratio in dual antiplatelet therapy
Method
Population: • Inclusion: All patients with MRI and FAZEKAS score • Exclusion: Patients with missing values of FAZEKAS score and mRS score Primary intervention/exposure variable: FAZEKAS score Wmc_cat: White matter lesion volume White matter lesion ratio= Wmc_cat/ WhiteVolume×100%
Conclusion
In patients with minor stroke, both SDWMHs and PVWMHs might related with initial stroke severity. No interaction was detected between the severity of WMHs and antiplatelet treatment.
Main results
Among the 787 patients in this analysis, 432 (54.9%) had moderate or severe WMHs (3-6). Compared with mild WMHs, the adjusted odds ratio (OR) of severe WMHs for risk of higher NIHSS was 2.10, 95% confidence interval (CI), 1.26–3.48 (P=0.004). Both severities of SDWMHs (OR 1.66; 95% CI, 1.15–2.40; P=0.007) and PVWMHs (OR 1.47; 95% CI, 1.02–2.10; P=0.04) were associated with higher NIHSS scores. There were no statistically significant associations of WMHs with 3-month functional outcome and stroke recurrence. There were no significant interactions between WMHs and antiplatelet therapy.