Background and Purpose- Cerebral small vessel disease (SVD) is associated with increased stroke risk and poor stroke outcomes. We aimed to evaluate whether chronic SVD burden is associated with poor recruitment of collaterals in large-vessel occlusive stroke. Methods- Consecutive patients with middle cerebral artery or internal carotid artery occlusion presenting within 6 hours after stroke symptom onset who underwent thrombectomy from 2012 to 2017 were included. The prespecified primary outcome was poor collateral flow, which was assessed on baseline computed tomographic angiography (poor, ≤50% filling; good, >50% filling). Markers of chronic SVD on brain magnetic resonance imaging were rated for the extent of white matter hyperintensities, enlarged perivascular spaces, chronic lacunar infarctions and cerebral microbleeds using the Standards for Reporting Vascular Changes on Neuroimaging criteria. Severity of SVD was quantified by adding the presence of each SVD feature, with a total possible score of 0 to 4; each SVD type was also evaluated separately. Multivariable logistic regression analyses were performed to evaluate the relationships between SVD and poor collaterals, with adjustment for potential confounders. Results- Of the 100 eligible patients, the mean age was 65±16 years, median National Institutes of Health Stroke Scale score was 15, and 68% had any SVD. Poor collaterals were observed in 46%, and those with SVD were more likely to have poor collaterals than patients without SVD (aOR, 1.9 [95% CI, 1.1-3.2]). Of the SVD types, poor collaterals were significantly associated with white matter hyperintensities (aOR, 2.9 per Fazekas increment [95% CI, 1.6-5.3]) but not with enlarged perivascular spaces (adjusted odds ratio [aOR], 1.3 [95% CI, 0.4-4.0]), lacunae (aOR, 2.1 [95% CI, 0.6-7.1]), or cerebral microbleeds (aOR, 2.1 [95% CI, 0.6-7.8]). Having a greater number of different SVD markers was associated with a higher odds of poor collaterals (crude trend P<0.001; adjusted P=0.056). There was a dose-dependent relationship between white matter hyperintensity burden and poor collaterals: adjusted odds of poor collaterals were 1.5, 3.0, and 9.7 across Fazekas scores of 1 to 3 (Ptrend=0.015). No patient with an SVD score of 4 had good collaterals. Conclusions- Chronic cerebral SVD is associated with poor recruitment of collaterals in large vessel occlusive stroke. A prospective study to elucidate the potential mechanism of how SVD may impair the recruitment of collaterals is ongoing.

中文翻译：

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脑小血管疾病会损害侧支招募。

背景与目的-脑小血管疾病（SVD）与中风风险增加和中风结果差有关。我们旨在评估慢性SVD负担是否与大血管闭塞性卒中抵押品募集不良有关。方法-纳入2012至2017年中风症状发作后6小时内出现脑中动脉或颈内动脉闭塞的连续患者。预先确定的主要结局是侧支血流不畅，这是通过基线计算机断层血管造影评估的（不良，≤50％充盈；良好，> 50％充盈）。对脑部磁共振成像上慢性SVD的标记物进行了白质高信号，血管周间隙扩大，慢性腔隙性脑梗死和脑微出血，使用神经影像学标准报告血管变化标准。通过添加每个SVD功能的存在来量化SVD的严重程度，总可能得分为0到4；每种SVD类型也分别进行了评估。进行多变量logistic回归分析以评估SVD与不良抵押品之间的关系，并对潜在的混杂因素进行调整。结果-在100名符合条件的患者中，平均年龄为65±16岁，美国国立卫生研究院卒中量表评分中位数为15，有68％的患者患有SVD。观察到46％的抵押品较差，与没有SVD的患者相比，有SVD的抵押品更容易出现不良抵押品（aOR，1.9 [95％CI，1.1-3.2]）。在SVD类型中，不良的侧支与白质高强度显着相关（aOR，每Fazekas增高2.9 [95％CI，1.6-5.3]），但与血管周围间隙增大无关（校正比值比[aOR]，1.3 [95％CI，0.4-4.0] ），腔隙（aOR，2.1 [95％CI，0.6-7.1]）或脑微出血（aOR，2.1 [95％CI，0.6-7.8]）。具有更多数量的不同SVD标记与不良抵押品的可能性更高（原油趋势P <0.001；调整后的P = 0.056）。白质过度紧张负担与不良抵押品之间存在剂量依赖性关系：在1到3的Fazekas评分中，不良抵押品的调整后赔率分别为1.5、3.0和9.7（Ptrend = 0.015）。SVD评分为4的患者均无良好的侧支。结论-慢性脑SVD与大血管闭塞性中风的侧支补充不良有关。