London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 521 443 Small vessel stroke and white matter disease Premature white matter changes on brain imaging in relation to ischaemic stroke subtypes: population-based case-control study L.-X. Li1, M. Simoni2, W. Küker3, U.G. Schulz4, S. Christie5, G.K. Wilcock6, P.M. Rothwell7 Stroke prevention research Unit,Nuffield Department of Clinical Neurosciences, John Rad-cliffe Hospital, University of Oxford, UK, Oxford, UNITED KINGDOM1, Stroke prevention research Unit, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Universi-ty of Oxford, UK, Oxford, UNITED KINGDOM2, Department of Neuroradiology, John Radcliffe Hospital, Oxford, UK, Oxford, UNITED KINGDOM3, Stroke prevention research Unit, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, UK, Oxford, UNITED KINGDOM4, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Univer-sity of Oxford, UK, Oxford, UNITED KINGDOM5, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, University of Oxford, UK, Oxford, UNITED KINGDOM6, Stroke prevention re-search Unit, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, UK, Oxford, UNITED KINGDOM7 BACKGROUND: Cohort studies show that white matter changes (WMC) on brain imaging are associated with an increased risk of ischaemic stroke. However, although WMC are most frequent in lacunar stroke it is uncertain how this association varies with age and, in the absence of com-parisons with normal controls, whether WMC are also more frequent than expected in other stroke subtypes. We compared the frequency and severity of WMC in different aetiological subtypes of TIA and ischaemic stroke versus healthy controls. METHODS: In a population-based case-control study of incident TIA/stroke patients (Oxford Vascular Study) and healthy age-matched controls (Oxford Projects to Investigate Memory and Ageing Study), we evaluated the presence and severity of WMC on CT and MRI brain imaging using modified Blennow/Fazekas scale and ARWMC scale. Age-specific prevalence and severity of WMC in cases vs. controls was stratified by aetiological subtype (TOAST). RESULTS: Among 1765 incident TIA/stroke cases and 358 controls, WMC were evaluated with CT brain imaging in 1453 cases and 313 controls and with MRI brain imaging in 562 cases and 131 controls. After adjustment for age, sex and hypertension, moderate-to-severe WMC (ARWMC scale) were more frequent in lacunar events than in controls (OR: 2.93, 95%CI1.86-4.62, p<0.0001) but not in large artery (1.45, 0.87-2.41), cardioembolic (0.99, 0.65-1.51) or undetermined (1.02, 0.69-1.51) subtypes. The association with lacunar events decreased with age (<75 years - 4.50, 1.93-10.45; 75-84 - 3.99, 1.97-8.06; ≥85 -1.23, 0.40-3.73). Results were consistent for other WMC scales and for MRI and CT separately. CONCLUSIONS: In the first such case-control study, WMC were strongly associated with lacunar TIA and stroke at younger ages, suggesting a shared aetiology that does not appear to be explained by traditional risk factors. In contrast, WMC did not appear to indicate an increased susceptibility to acute ischaemic events of non-lacunar aetiology. 444 Small vessel stroke and white matter disease Skin microvascular function is impaired in patients with small vessel disease stroke but not in patients with large vessel disease stroke when compared to healthy controls. S. Elyas1, D. Adingupu2, C. Thorn3, P.E. Gates4, A.C. Shore5, W.D. Strain6 Exeter University Medical School, Exeter, UNITED KINGDOM1, Exeter University Medical School, Exeter, UNITED KINGDOM2, Exeter University Medical School, Exeter, UNITED KING-DOM3, Exeter University Medical School, Exeter, UNITED KINGDOM4, Exeter University Med-ical School, Exeter, UNITED KINGDOM5, Exeter University Medical School, Exeter, UNITED KINGDOM6 Background: The pathogenesis of cerebral small vessel disease (SVD) is not entirely clear. Indi-viduals with healthy microvascular responses respond to temporary ischaemic insults by increasing blood flow in the affected vascular bed to allow optimal oxygen and nutrients delivery and quicker recovery of the ischaemic tissue. We hypothesised that patients with cerebral SVD stroke would have an attenuated microvascular response to ischaemia compared to healthy controls, and that this would not be seen in those with large vessel disease stroke (LVD). Methods: 41 SVD patients, 44 LVD patients and 57 age and sex matched healthy controls were re-cruited. Skin reactive hyperaemia of the foot was induced using a 4 minute arterial occlusion of the ankle. Perfusion was recorded using laser Doppler fluximetry. Peak flux response, time to peak re-sponse (TTP) and duration of hyperaemia were recorded. Results: Peak response post ischaemia was lower in SVD patients compared to healthy controls (68 flux units (95%CI 58-79) vs. 85 (74-97) respectively, p=0.03). There was no difference in peak re-sponse between LVD patients vs. healthy controls (75 (65-86) vs. 85 (74-97) respectively, p=0.2). There was no difference in TTP between controls, SVD & LVD (14s (13-16), 14s (12-16) and 16s (14-19) respectively, ANOVA=0.23). Patients with SVD had a shorter hyperaemia duration compared to healthy controls (130s (95% CI 110-153) vs. 172s (148-199) respectively, p=0.018). There was no difference in hyperaemia dura-tion between LVD patients and healthy controls (148s (127-172) vs. 172s (148-199) respectively, p=0.13). Conclusion: Patients with SVD stroke have attenuated systemic microvascular responses to isch-aemia compared to healthy controls. This attenuation in microvasuclar function is not seen in those with LVD stroke. This is in keeping with the hypothesis that cerebral SVD is a manifestation of sys-temic microvascular dysfunction rather than a local disease.
Karger_ESC London_2013
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