RT Journal Article
SR Electronic
T1 Imaging markers of small vessel disease and brain frailty, and outcomes in acute stroke
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP e439
OP e452
DO 10.1212/WNL.0000000000008881
VO 94
IS 5
A1 Appleton, Jason P.
A1 Woodhouse, Lisa J.
A1 Adami, Alessandro
A1 Becker, Jennifer L.
A1 Berge, Eivind
A1 Cala, Lesley A.
A1 Casado, Ana M.
A1 Caso, Valeria
A1 Christensen, Hanne K.
A1 Dineen, Robert A.
A1 Gommans, John
A1 Koumellis, Panos
A1 Szatmari, Szabolcs
A1 Sprigg, Nikola
A1 Bath, Philip M.
A1 Wardlaw, Joanna M.
A1 ,
YR 2020
UL http://n.neurology.org/content/94/5/e439.abstract
AB Objective To assess the association of baseline imaging markers of cerebral small vessel disease (SVD) and brain frailty with clinical outcome after acute stroke in the Efficacy of Nitric Oxide in Stroke (ENOS) trial.Methods ENOS randomized 4,011 patients with acute stroke (<48 hours of onset) to transdermal glyceryl trinitrate (GTN) or no GTN for 7 days. The primary outcome was functional outcome (modified Rankin Scale [mRS] score) at day 90. Cognition was assessed via telephone at day 90. Stroke syndrome was classified with the Oxfordshire Community Stroke Project classification. Brain imaging was adjudicated masked to clinical information and treatment and assessed SVD (leukoaraiosis, old lacunar infarcts/lacunes, atrophy) and brain frailty (leukoaraiosis, atrophy, old vascular lesions/infarcts). Analyses used ordinal logistic regression adjusted for prognostic variables.Results In all participants and those with lacunar syndrome (LACS; 1,397, 34.8%), baseline CT imaging features of SVD and brain frailty were common and independently associated with unfavorable shifts in mRS score at day 90 (all participants: SVD score odds ratio [OR] 1.15, 95% confidence interval [CI] 1.07–1.24; brain frailty score OR 1.25, 95% CI 1.17–1.34; those with LACS: SVD score OR 1.30, 95% CI 1.15–1.47, brain frailty score OR 1.28, 95% CI 1.14–1.44). Brain frailty was associated with worse cognitive scores at 90 days in all participants and in those with LACS.Conclusions Baseline imaging features of SVD and brain frailty were common in lacunar stroke and all stroke, predicted worse prognosis after all acute stroke with a stronger effect in lacunar stroke, and may aid future clinical decision-making.Identifier ISRCTN99414122.CI=confidence interval; ENOS=Efficacy of Nitric Oxide in Stroke; GTN=glyceryl trinitrate; IST-3=Third International Stroke Trial; LACI-2=Lacunar Intervention Trial-2; LACS=lacunar syndrome; MD=mean difference; mRS=modified Rankin Scale; OCSP=Oxfordshire Community Stroke Project; OR=odds ratio; RIGHT-2=Rapid Intervention With Glyceryl Trinitrate in Hypertensive Stroke Trial–2; SPS3=Secondary Prevention of Small Subcortical Strokes; SSS=Scandinavian Stroke Scale; STIR=Stroke Imaging Repository; SVD=small vessel disease; t-MMSE=telephone Mini-Mental State Examination; TICS-M=modified Telephone Interview for Cognitive Status; VISTA=Virtual International Stroke Trials Archive