Presenter of 2 Presentations
RISK FACTOR PROFILE AND INFARCT SIZE IN SINGLE SUBCORTICAL ISCHEMIC STROKES: A MRI-BASED SINGLE-CENTER STUDY
RISK FACTOR PROFILE AND INFARCT SIZE IN SINGLE SUBCORTICAL ISCHEMIC STROKES: A MRI-BASED SINGLE-CENTER STUDY
Abstract
Background and Aims
Infarct size and location have a critical effect on ischemic stroke classification; studying their role independently of stroke etiology is challenging. We performed a retrospective, hypothesis-generating study assessing risk factor profile and infarct size in single subcortical infarcts.
Methods
We selected consecutive acute ischemic stroke patients, admitted to our Stroke Unit within 2008-2015, with adequate-quality brain MRI-DWI scans showing single subcortical infarction. Vascular territories were evaluated according to Tatu (1996-1998) atlas. Lesion volume was determined via 3D reconstruction of manually segmented MRI-DWI lesion contours. Association with risk factors was assessed with logistic regression models, controlling for stroke etiology (TOAST).
Results
We included 205 patients (72.7% males, median age 70 [IQR: 59–76]) with single acute subcortical infarction, of which: 13 cardioembolic (CE), 18 large-vessel occlusion (LVO), 121 small-vessel occlusion (SVO), 53 cryptogenic. Median infarct volume was 620 mm3 (IQR: 280–1020). Total number of major vascular risk factors in single patients (among hypertension, diabetes, hypercholesterolemia, smoke) decreased with larger infarct volume (-0.23 [CI:-0.46–0.00] for one log (10x) volume increase, p=0.05; Figure 1). Apart from hypertension (OR 1.28 [CI:0.63-2.55]), other risk factors suggested association with smaller infarct size (Figure 2): smoke (OR 0.55 [CI:0.31-0.98]), diabetes (OR 0.71 [CI:0.39-1.26]), hypercholesterolemia (OR 0.75 [CI:0.43-1.29]). Among minor risk factors, ipsilateral non-stenosing carotid plaque was associated with larger infarcts (OR 1.83 [CI:0.97-3.61]), left atrial dilation with smaller lesions (OR 0.46 [CI:0.22-0.96]).
Conclusions
In this exploratory analysis, we found relationships between cerebrovascular risk factors and subcortical single infarct size that may be valuable to refine assessment of the underlying stroke mechanism.