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Association between large artery stenosis, cerebral small vessel disease and risk of ischemic stroke

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Abstract

We aimed to assess the associations of large artery stenosis (LAS) and cerebral small vessel disease (CSVD) with the risk of ischemic stroke and to investigate their respective and combined contributions. In the prospective population-based Shunyi Study, 1,082 stroke-free participants aged 55.9±9.1 years were included. Participants were followed for incident stroke throughout the study period (2013–2019). Total small vessel disease score was used to measure CSVD burden. Cervico-cerebral large artery stenosis was evaluated via brain magnetic resonance angiography and carotid ultrasound. We estimated the risk of ischemic stroke in relation to LAS and CSVD with Cox regression models. During a mean follow-up of 4.2 years, 34 participants (3.1%) experienced at least one ischemic stroke. Severe LAS (≥50% stenosis versus no stenosis: HR=3.27 (95% CI: 1.31–8.18)) and high CSVD burden (total small vessel disease score 2–4 versus 0 point: HR=12.73 (4.83–33.53)) were associated with increased stroke risk independently. In multivariate models, CSVD burden (7.72%) explained a larger portion of the variation in stroke risk than severity of LAS (3.49%). Our findings identified that both LAS and CSVD were associated with future ischemic stroke in asymptomatic subjects, while those with high CSVD burden deserve more attention in primary prevention of stroke.

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Acknowledgements

The authors are grateful to the study participants, and the staff of the Shunyi Study. This study was supported by the National Key Research and Development Program of China (2016YFB1001402), National Natural Science Foundation of China (81971138), Chinese Academy of Medical Sciences (CAMS) Innovation Fund for Medical Sciences (CIFMS) (2017-I2M-3-008), Strategic Priority Research Program (Pilot study) “Biological basis of aging and therapeutic strategies” of the Chinese Academy of Sciences (XDPB10), and Research Foundation for Young Scholars of Peking Union Medical College Hospital (PUMCH201911275).

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Authors and Affiliations

  1. Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China

    Fei Han, Fei-Fei Zhai, Jiang-Tao Zhang, Li-Xin Zhou, Jun Ni, Ming Yao, Li-Ying Cui & Yi-Cheng Zhu

  2. Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China

    Ding-Ding Zhang

  3. Department of Echocardiography, China Emergency General Hospital, Beijing, 100730, China

    Jun Xue

  4. Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China

    Jun Xue, Meng Yang & Qing Dai

  5. Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China

    Shuang Yan, Ming-Li Li & Zheng-Yu Jin

  6. Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100005, China

    Shu-Yang Zhang

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  1. Fei Han
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Correspondence to Yi-Cheng Zhu.

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Compliance and ethics The author(s) declare that they have no conflict of interest. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standard. This study was approved by the institutional review board at Peking Union Medical College Hospital in Beijing, China. Informed consent was obtained from all individual participants included in the study.

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Han, F., Zhang, DD., Zhai, FF. et al. Association between large artery stenosis, cerebral small vessel disease and risk of ischemic stroke. Sci. China Life Sci. 64, 1473–1480 (2021). https://doi.org/10.1007/s11427-020-1849-x

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  • DOI: https://doi.org/10.1007/s11427-020-1849-x

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