Clinical Associations and Prognostic Value of MRI-Visible Perivascular Spaces in Patients With Ischemic Stroke or TIA: A Pooled Analysis

• Published in: Neurology Vol. 102; no. 1; p. e207795
• Main Authors: Best, Jonathan G, Ambler, Gareth, Wilson, Duncan, Du, Houwei, Lee, Keon-Joo, Lim, Jae-Sung, Teo, Kay Cheong, Mak, Henry, Kim, Young Dae, Song, Tae-Jin, Selcuk Demirelli, Derya, Nishihara, Masashi, Yoshikawa, Masaaki, Kubacka, Marta, Zietz, Annaelle, Al-Shahi Salman, Rustam, Jäger, Hans Rolf, Lip, Gregory Y H, Panos, Leonidas, Goeldlin, Martina B, Slater, Lee-Anne, Karayiannis, Christopher Charles, Phan, Thanh G, Bellut, Maximilian, Abrigo, Jill, Cheng, Cyrus, Leung, Thomas W, Chu, Winnie, Chappell, Francesca, Makin, Stephen D J, van Dam-Nolen, Dianne H K, Kooi, M Eline, Köhler, Sebastian, Staals, Julie, Kuchcinski, Grégory, Bordet, Régis, Dubost, Florian, Wardlaw, Joanna M, Soo, Yannie O Y, Fluri, Felix, Srikanth, Velandai K, Jung, Simon, Peters, Nils, Hara, Hideo, Yakushiji, Yusuke, Necioglu Orken, Dilek, Heo, Ji-Hoe, Lau, Gary Kui Kai, Bae, Hee-Joon, Werring, David J
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 09-01-2024
• Subjects: Aged; Cerebral Hemorrhage; Cerebral Small Vessel Diseases - complications; Cerebral Small Vessel Diseases - diagnostic imaging; Female; Humans; Intracranial Hemorrhages; Ischemic Attack, Transient - complications; Ischemic Attack, Transient - diagnostic imaging; Ischemic Stroke; Magnetic Resonance Imaging; Male; Prognosis; Prospective Studies; Stroke - diagnostic imaging
• ISSN: 0028-3878; 1526-632X
• DOI: 10.1212/WNL.0000000000207795

Visible perivascular spaces are an MRI marker of cerebral small vessel disease and might predict future stroke. However, results from existing studies vary. We aimed to clarify this through a large collaborative multicenter analysis.
We pooled individual patient data from a consortium of prospective cohort studies. Participants had recent ischemic stroke or transient ischemic attack (TIA), underwent baseline MRI, and were followed up for ischemic stroke and symptomatic intracranial hemorrhage (ICH). Perivascular spaces in the basal ganglia (BGPVS) and perivascular spaces in the centrum semiovale (CSOPVS) were rated locally using a validated visual scale. We investigated clinical and radiologic associations cross-sectionally using multinomial logistic regression and prospective associations with ischemic stroke and ICH using Cox regression.
We included 7,778 participants (mean age 70.6 years; 42.7% female) from 16 studies, followed up for a median of 1.44 years. Eighty ICH and 424 ischemic strokes occurred. BGPVS were associated with increasing age, hypertension, previous ischemic stroke, previous ICH, lacunes, cerebral microbleeds, and white matter hyperintensities. CSOPVS showed consistently weaker associations. Prospectively, after adjusting for potential confounders including cerebral microbleeds, increasing BGPVS burden was independently associated with future ischemic stroke (versus 0-10 BGPVS, 11-20 BGPVS: HR 1.19, 95% CI 0.93-1.53; 21+ BGPVS: HR 1.50, 95% CI 1.10-2.06;
= 0.040). Higher BGPVS burden was associated with increased ICH risk in univariable analysis, but not in adjusted analyses. CSOPVS were not significantly associated with either outcome.
In patients with ischemic stroke or TIA, increasing BGPVS burden is associated with more severe cerebral small vessel disease and higher ischemic stroke risk. Neither BGPVS nor CSOPVS were independently associated with future ICH.