Association of Leukoaraiosis with Stroke Recurrence within 5 Years after Initial Stroke

• Published in: Journal of stroke and cerebrovascular diseases Vol. 24; no. 3; pp. 573 - 582
• Main Authors: Kumral, Emre, MD, Güllüoğlu, Halil, MD, Alakbarova, Naila, MD, Karaman, Bedriye, MD, Deveci, Emrah Emre, MD, Bayramov, Aydın, MD, Evyapan, Dilek, MD, Gökçay, Figen, MD, Orman, Mehmet, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-03-2015
• Subjects: Adult; Aged; Aged, 80 and over; Cardiovascular; Chi-Square Distribution; Female; Humans; Kaplan-Meier Estimate; large artery disease; Leukoaraiosis; Leukoaraiosis - diagnosis; Leukoaraiosis - epidemiology; Leukoaraiosis - mortality; Male; Middle Aged; Multivariate Analysis; Neurology; Odds Ratio; Prognosis; Proportional Hazards Models; Prospective Studies; Recurrence; Registries; Risk Assessment; Risk Factors; Severity of Illness Index; small artery disease; Stroke - diagnosis; Stroke - epidemiology; Stroke - mortality; stroke recurrence; Time Factors; Turkey - epidemiology; Turkey; small artery disease; Leukoaraiosis; large artery disease; stroke recurrence
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2014.10.002

Background Leukoaraiosis (LA) is closely associated with stroke. Despite the fact that LA has consistently been shown to predict development of recurrent stroke, prior studies on the association of LA and stroke subtypes have been unsatisfactory. In this study, we sought to identify whether LA contributes to the recurrence of certain subtypes of stroke at long term. Methods Data from the Ege Stroke Registry were examined, and 5 years follow-up data for LA and stroke recurrence were analyzed. We performed survival curves using the Kaplan–Meier method (unadjusted) and log-rank tests in patients with stroke to determine the relationship between LA and recurrent stroke by stroke subtypes within a time period of 5 years. Multivariate survival analyses were undertaken using Cox proportional hazards models to determine the prognostic value of LA, stroke subtypes, and other vascular risk factors before recurrent stroke. Results Of 9522 patients with stroke, 1280 (26%) with LA and 901 (19%) without LA experienced a stroke recurrence within 5 years of follow-up (odds ratio, 1.53; 95% confidence interval, 1.39-1.69). After stratification by stroke subtypes, multivariable analysis revealed a significant association between LA and large artery disease (LAD; odds ratio [OR], 1.39; 95% confidence interval [CI], 1.18-1.64), small artery disease (SAD; OR, 1.57; 95% CI, 1.27-1.94), and intracerebral hemorrhage (ICH; OR, 1.88; 95% CI, 1.32-2.66), except cardioembolic stroke and “other” stroke subtypes at 5 years after stroke onset. The survival analysis showed that stroke recurrence was significantly higher in patients with severe LA compared with those with mild/moderate LA (log-rank test [Mantel–Cox], P  < .001). Conclusions Our results showed that LA is related to the recurrent strokes in patients with stroke within 5 years after stroke, specifically to the LAD, SAD and ICH.