Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases

Journal：Stroke and Vascular Neurology

Publication type: Original Contributions

IF(IF): 4.081

PMID: 32606085 Link To Pubmed Full text Download

Minor ischemic stroke and transient ischemic attack (TIA) are two common types of acute cerebrovascular disease. Relatively slight or transient neurological impairment at onset of the index event but high risk of recurrence and disability afterwards calls for more investigations on determinants to predict the prognosis of minor stroke and TIA. Magnetic resonance imaging (MRI) provides a valuable insight into the pathophysiology of ischemic stroke and a useful tool to evaluate its prognosis. For instance, intracranial arterial stenosis (ICAS), a crucial cause and well-established pathology of ischemic stroke, can be efficiently detected and evaluated by MRI, representing atherosclerosis burden of relatively large cerebral arterials. By contrast, intracranial small vessels are not directly visible on routine MRI, while white matter hyperintensity (WMH), lacune, enlarged perivascular space (PVS), microbleeds feature imaging markers of cerebral small vessel disease (CSVD). However, consequence of CSVD regarding stroke remains less clear. Up to date, emerging evidence suggests that CSVD may affect the prognosis of ischemic stroke in various respects. However, it has also been highlighted that CSVD and ICAS may be two distinct entities, considering vascular mechanism only accounts for no more than 2% of WMH compared with 70% for large-artery atheromatous disease. With different mechanism, CSVD and ICAS may serve as separate vascular pathology and play different roles on outcomes of ischemic stroke. Furthermore, whether CSVD is associated with stroke recurrence has been controversial. A post-hoc analysis of SAMPPRIS trial showed a lack of association between CSVD and stroke recurrence, while study of OXVASC and HKU cohorts reported oppositely. The questions whether, in what aspect and at what level CSVD and ICAS are associated with the outcomes of ischemic stroke remain unanswered. In this pre-specified imaging substudy of the CHANCE trial, we aim to investigate the roles of CSVD and ICAS on different outcomes (i.e. new stroke, modified Rankin Scale [mRS], and any bleeding event) at 3-month follow-up in patients with minor stroke and TIA.

Kaplan-Meier curves will be used to present the time to the primary efficacy outcome event for each group. The associations of burdens of CSVD and ICAS with outcomes at 3-month will be assessed by multivariate Cox regression model. Adjusted hazard ratios (HRs) and their 95% confidence intervals (CIs) will be calculated.