Pre-existing Cerebral Small Vessel Disease in Young Patients with Acute Ischemic Stroke caused by Large Artery Atherosclerosis or Small Artery Occlusion

Abstract

Objective: To explore the characteristics of pre-existing Cerebral Small Vessel Disease (CSVD) in young patients with Acute Ischemic Stroke (AIS) caused by large artery atherosclerosis or small artery occlusion. Methods: A total of 400 patients with suspected stroke or transient ischemic attack who aged 18–45 years old were included in this retrospective study. Demography data, vascular risk factors and primary CSVD were compared between patients with AIS and non-stroke or between patients with different subtypes of AIS. Results: The levels of cerebrovascular risk factors were significantly higher in patients with AIS than those with non-stroke (p < 0.05). The majority of patients with large artery atherosclerotic stroke or small artery occlusive stroke were male. The age was slightly younger and the NIH stroke scale (NIHSS) score at admission were higher in large artery atherosclerotic stroke group than small artery occlusive stroke group. White matter hyperintensities, moderate and extensive enlarged perivascular space, 1–3 points of total score were more commonly observed in patients with AIS than those with non-stroke (p < 0.05). Male and diabetes were the risk factors of lacune infarctions (p < 0.05). Male, hypertension and primary CSVD were the risk factors of both of strokes (p < 0.05). The enlarged perivascular space notably increased the risk of large artery atherosclerotic stroke (p = 0.033). Conclusion: Male, age, hypertension, diabetes and pre-existing CSVD were the risk factors of young patients with AIS. For young adults, once asymptomatic CSVD abnormalities were detected, cerebrovascular risk factors should be screened and pre-existing prevention measures for stroke should be taken.

Keywords

• Young
• pre-existing cerebral small vessel disease
• acute ischemic stroke
• large artery atherosclerosis
• small artery occlusion