Author(s): Aziza Al Azri*, Sameer Raniga, Arunodaya Gajjar and Faisal Al Azri
Background and Objectives: Cerebral Small Vessel Disease (CSVD) is a syndrome of clinical and imaging findings thought to arise from a disease affecting cerebral small vessels- perforating arterioles, capillaries, venules. CSVD causes abut a quarter of the acute ischemic stroke (AIS) and increases the risk of the large vessel stroke. It is also the most common cause of vascular dementia and causes cognitive impairment as well as depression.
MRI is the investigation of choice to detect and characterize CSVD. MRI biomarkers of CSVD includes- lacunes, white matter hyperintensities, microbleed, prominent Virchow-Robin spaces and acute subcortical infarction. Risk factors for SVD include hypertension, DM, dyslipidemia, smoking, ischemic heart disease, and alcohol consumption.
The objective of this research is primarily to study the Incidence/prevalence of small vessel disease (CSVD) on MRI in patients presents with AIS at SQUH. The secondary objectives were to analyze the risk factors for CSVD, to study different MRI biomarkers of the CSVD, and to analyze the outcome of stroke due to CSVD.
Methods: This is a retrospective observational single-centre study conducted at the Sultan Qaboos University Hospital, Muscat, Oman. The study population was patients presented to the SQUH emergency department with stroke between 2016-2018 (3 years). The study was conducted between April 2018– March 2019 (12 months). After applying the inclusion and exclusion criteria, the final study population was 206 patients. Each patient was evaluated for the presence and type of different MRI biomarkers of CSVD- lacunes, white matter hyperintensities, microbleed, prominent Virchow-Robin spaces and acute subcortical infarction. The findings were correlated with demographics and conventional stroke-related risk factors (HTN, DM, hyperlipidemia, ischemic heart disease). The outcome was evaluated by used of modified ranskin score.
Results: Of 206 patients, there were about 40.8% shows CSVD as a cause for the stroke (TOAST 3). In the remaining patients, the AIS was due to large vessels, cardioembolic and other causes (Non-TOAST 3). Hypertension was the most common risk factor contribute to CSVD with 70.4%, followed by diabetes with 65.9%, hyperlipidemia 32.1% and IHD 31.9 %,
Conclusion: Cerebral small vessels disease as a cause for AIS was seen in 40.8 % of the studied population at SQUH. Risk factors like HTN, DM, smoking, and atrial fibrillation are strongly associated with CSVD. Hypertension is the most prevalent and important risk factor for stroke in general. Lacunes and prominent perivascular spaces are the commonest MRI biomarkers of CSVD in our study population. No statistically significant difference in the outcome of stroke due to small vessel disease (TOAST-3) versus non-small vessel disease (non-TOAST 3).
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