22. European Stroke Conference 2 Small vessel stroke and white matter disease 14:40 - 14:50 Early and three month follw up 3Tesla MRI imaging of a cohort of patients with lacunar stroke G. Gulli1, N. Micheletti2, G. Tomelleri3, M. Cappellari4, P. Bovi5, G. Moretto6, F.B. Pizzini7 Stroke Unit, UOC Neurologia, DAI di Neuroscienze, Azienda Ospedaliera Universi-tari Integrata, Verona, Verona, ITALY1,UOC Neurologia, DAI di Neuroscienze, Azienda Ospedaliera Universitari Integrata, Verona, Verona, ITALY2, UOC Neurologia, DAI di Neu-roscienze, Azienda Ospedaliera Universitari Integrata, Verona, Verona, ITALY3, Stroke Unit, UOC Neurologia, DAI di Neuroscienze, Azienda Ospedaliera Universitari Integrata, Verona, Verona, ITALY4, UOC Neurologia, DAI di Neuroscienze, Azienda Ospedaliera Universitari In-tegrata, Verona, Verona, ITALY5, UOC Neurologia, DAI di Neuroscienze, Azienda Ospedaliera Universitari Integrata, Verona, Verona, ITALY6, UOC Neuroradiologia, DAI Patologia e Diag-nostica, Azienda Ospedaliera Universitari Integrata, Verona, Verona, ITALY7 Background High resolution neurovascular imaging may contribute to the clarification of mechanisms caus-ing small vessel disease (SVD). This prospective pilot study evaluates a cohort of patients with lacunar stroke studied by mean of high resolution 3 T MRI. Methods 19 patients with lacunar stroke were recruited and 3T MRI (FLAIR-GRE-DWI-MRI-angio) scan was performed within 10 days from the event and at three months. SVD severity was as-sessed by Fazekas scale. Results First MRI - the mean lesion volume of the acute lacunar infarct on DWI was 1,04 cm3. Patients were divided into two groups according to the starting Fazekas scale score. 13 patients had MID SVD (Fazekas 1-2), 6 patients had MODERATE to SEVERE SVD (Fazekas 3-6). 23% (3/13) of MID patiens and 83% (5/6) of MOD-SEV patients have at least 1 GRE + lesion on the first scan. Follow up MRI - 3 patients in the MOD-SEV group and no patients in the MID group had at least one new asymptomatic DWI+ lesion in the follow-up scan. 2 patients in the MOD-SEV group and no patients in the MID group showed either enlarged or additional GRE+ lesions. All patients with new DWI lesions or enlarged/additional GRE lesions were started on new an-ti- platelet treatment after the first event. The FAZEKAS score increased from 1 to 2 in three MID patients and remained unchanged in all MOD-SEV patients. Angio RM - No patient has shown sign of intracranial arteriosclerosis in the angioMRI both in the first and second exam. Discussion The evolution of SVD may be rapid (i.e. < 3 months). Subclinical vascular events in patients with moderate to severe SVD occur even when antiplatelet treatment is started, suggesting that SVD in these patients is not a thrombotic process. Long term benefit of antiplatelet treatment in MOD-SEV patients, who also may show new GRE lesions at three months, must be tested in larger and randomised trials. In our cohort, intracranial arteriosclerosis did not seem to play a role in the pathogenesis of SVD. Figure 1. Odds Ratio (95% CI) for progression of WML between quintiles of HCY level (in μmol/L) compared to lowest quintile. Lowest quintile used as reference. Analysis adjusted for age, sex, follow-up time, baseline WML volume, eGFR, systolic blood pressure, diastolic blood pressure, diabetes mellitus, BMI, cholesterol level, smoking, alcohol use, IMT 38 © 2013 S. Karger AG, Basel Scientific Programme
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