In patients who had a stroke or TIA, enlarged perivascular spaces in basal ganglia may cause future haemorrhagic strokes  

作　　者：Yu Tian Mengxing Wang Yuesong Pan Xia Meng Xingquan Zhao Liping Liu Yongjun Wang Yilong Wang 

机构地区：[1]Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing,China [2]Chinese Institute for Brain Research,Beijing,China [3]National Center for Neurological Diseases,Beijing,China [4]Advanced Innovation Center for Human Brain Protection,Capital Medical University,Beijing,China [5]China National Clinical Research Center for Neurological Diseases,Beijing,China

出　　处：《Stroke & Vascular Neurology》2024年第1期8-17,I0001-I0033,共43页卒中与血管神经病学（英文）

基　　金：supported by grants from the National Natural Science Foundation of China(No.81825007);Beijing Outstanding Young Scientist Program(No.BJJWZYJH01201910025030);National Key R&D Program of China(2016YFC0901002);Youth Beijing Scholar Program(No.010);"National Ten-Thousand Talent Plan"-Leadership of Scientific and Technological Innovation,Capital's Funds for Health Improvement and Research(2022-2-2045);Beijing Talent Project-Class A:Innovation and Development(2018A12);National Key R&D Program of China(2017YFC1307900).

摘　　要：Introduction It remains unclear whether enlarged perivascular spaces(EPVS)predict poor clinical outcomes in patients with acute ischaemic stroke(AIS)or transient ischaemic attack(TIA).Method Data were obtained from the Third China National Stroke Registry study.We estimated EPVS in basal ganglia(BG)and centrum semiovale(CSO)using a semiquantified scale(Grade from 0 to 4).Using Cox and logistic regression analyses,the associations of EPVS with 3-month and 1-year adverse outcomes(including recurrent stroke,ischaemic stroke,haemorrhagic stroke,combined vascular event,disability and mortality)were explored.Sensitivity analyses of any association of cerebral small vessel disease at baseline and development of a small arterial occlusion(SAO)were conducted.Result Among 12603 patients with AIS/TIA,median age was 61.7±11.6 years,and 68.2%were men.After adjusting for all potential confounders,frequent-to-severe BG-EPVS was associated with a decreased risk of recurrent ischaemic stroke(HR 0.71,95%CI 0.55 to 0.92,p=0.01)but an increased risk of haemorrhagic stroke(HR 1.99,95%CI 1.11 to 3.58,p=0.02)at 1 year after AIS/TIA,compared with none-to-mild BG-EPVS.Patients with frequent-to-severe CSO-EPVS had a decreased risk of disability(OR 0.76,95%CI 0.62 to 0.92,p=0.004)and all-cause death(HR 0.55,95%CI 0.31 to 0.98,p=0.04)within 3-month but not 1-year follow-ups,compared with those with none-to-mild BG-EPVS.Sensitivity analyses showed that both BG-EPVS(HR 0.43,95%CI 0.21 to 0.87,p=0.02)and CSO-EPVS(HR 0.58,95%CI 0.35 to 0.95,p=0.03)were associated with a decreased risk of subsequent ischaemic stroke in patients with SAO during 1-year follow-up.Conclusion BG-EPVS increased the risk of haemorrhagic stroke in patients already with AIS/TIA within 1 year.Therefore,caution is recommended when selecting antithrombotic agents for secondary stroke prevention in patients with AIS/TIA and more severe BG-EPVS.

关 键 词：PATIENTS haemorrhagic prevention 

分 类 号：R743.3[医药卫生—神经病学与精神病学]