The association of white matter hyperintensities with stroke outcomes and antiplatelet therapy in minor stroke patients

Yu-Yuan Xu, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.
Li-Xia Zong, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.
Chang-Qing Zhang, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.
Yue-Song Pan, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.
Jing Jing, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.
Xia Meng, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.
Hao Li, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.
Xing-Quan Zhao, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.
Li-Ping Liu, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.
David Wang, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, USA.Follow
Yi-Long Wang, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.
Yong-Jun Wang, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.

Document Type

Article

Abstract

BACKGROUND: To characterize the severity and distribution of white matter hyperintensities (WMHs) and to assess the relationship of WMHs with initial stroke severity, 3-month functional outcome, stroke recurrence and response to antiplatelet therapies. METHODS: In Clopidogrel High-risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) trial, 787 minor stroke patients with baseline magnetic resonance imaging (MRI) information were included in this analysis. Deep and periventricular WMHs (DWMHs and PVWMHs) were rated using the Fazekas scale and categorized into mild (grades 0-2), moderate (grades 3-4) and severe (grades 5-6). Multivariable logistic regression was used to examine the associations between WMHs severities and outcomes, including initial stroke severity by the National Institutes of Health Stroke Scale (NIHSS) scores, 3-month functional outcome by modified Rankin Scale (mRS), and stroke recurrence. Cox proportional hazards model was used to assess the treatment-by-subgroup interaction effect. 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. CONCLUSIONS: 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. ClinicalTrials.gov identifier: NCT00979589. Date of registration: Sep 18, 2009.

Publication Date

3-1-2020

Publication Title

Annals of translational medicine

ISSN

2305-5839

Volume

8

Issue

6

First Page

331

PubMed ID

32355775

Digital Object Identifier (DOI)

10.21037/atm.2020.02.137

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