Cerebral Small Vessel Disease is Associated with Prehospital Delay in Acute Ischemic Stroke

Overview

Journal J Atheroscler Thromb

Date 2024 Sep 4

PMID 39231653

Authors

Marina Masui

Takeo Sato

Motohiro Okumura

Takahiro Ishikawa

Kenichi Sakuta

Tatsushi Kokubu

Junichiro Takahashi

Tomomichi Kitagawa

Maki Tanabe

Asako Onda

Teppei Komatsu

Kenichiro Sakai

Tadashi Umehara

Hidetaka Mitsumura

Yasuyuki Iguchi

Affiliations

Soon will be listed here.

Abstract

Aim: To determine whether the severity of cerebral small vessel disease (SVD) is associated with prehospital delay in acute ischemic stroke.

Methods: Consecutive patients with ischemic stroke were included in this study. We evaluated the SVD burden using the total SVD score. Patients were divided into 2 groups: onset-to-door time within 4.5 hours (early arrival group) and onset-to-door time over 4.5 hours (delayed arrival group). First, we assessed whether the total SVD score was related to prehospital delay using a logistic regression analysis. Second, we assessed which item of the score was independently associated with delays. Finally, we determined whether the item had a linear association with the delay.

Results: Of the 2,112 screened patients, 1,754 were enrolled in the study (1,253 males [71%]; median age, 69 years). There were 1,105 patients (63%) in the delayed arrival group. The total SVD score was independently associated with delay (OR 1.11, 95% CI 1.01-1.21, p=0.025). Among the 4 items of the score, only enlarged perivascular spaces (EPVS) in the basal ganglia was independently associated with delay (OR 1.37, 95% CI 1.05-1.80, p=0.022). A linear trend was observed between EPVS grade and delay with reference to EPVS grade 0-1 (EPVS grade 2: OR 1.22, 95% CI 0.92-1.62, p=0.170, EPVS grade 3: OR 1.69, 95% CI 1.20-2.38, p=0.002, EPVS grade 4: OR 2.17, 95% CI 1.37-3.44, p=0.001).

Conclusions: Prehospital delay in acute ischemic stroke could be associated with the severity of SVD, particularly EPVS in the basal ganglia.

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