Association Between Extracranial Artery Stenosis and Cerebral Small-Vessel Disease in Patients with Ischemic Stroke.

Objective: To review the relationship between extracranial artery stenosis (ECAS) severity and total cerebral small-vessel disease (CSVD) burden and evaluated 5-year mortality, disability, and stroke recurrence in ischemic stroke patients. Cerebral small-vessel disease and ECAS often share risk factors such as hypertension and atherosclerosis and coexist in ischemic stroke. Although ECAS affects large-artery disease, its impact on total CSVD burden on MRI and subsequent clinical outcomes is not well defined. Methods: We retrospectively reviewed the medical records of 348 patients older than 35 who had suffered acute ischemic stroke and were admitted to selected hospitals in Tehran, Iran from March 2018-March 2020. The patients were stratified into 4 ECAS groups, and brain MRIs were scored to yield a total CSVD burden score. Ordinal logistic regression was used to examine the association between ECAS category and CSVD score, adjusting for age, sex, hypertension, diabetes mellitus, and hyperlipidemia. Logistic regression assessed 5-year outcomes. Results: Of the 309 patients with complete imaging, increasing ECAS severity was independently associated with a higher CSVD burden (adjusted OR 1.86; 95% CI 1.56-2.22; p<0.001). Five-year mortality was 39.9%, and severe ECAS predicted lower survival rates (adjusted OR 2.43; 95% CI 1.02-5.78; p = 0.045). However, ECAS was not linked to disability (p = 0.077) or recurrence (p = 0.191). Conclusions: We found that ECAS severity correlated with greater CSVD burden and poorer long-term survival in ischemic stroke.