Enlarged perivascular spaces and hemorrhagic transformation after acute ischemic stroke

BACKGROUND: Enlarged perivascular spaces (EPVS) are considered to be neuroimaging markers of cerebral small vessel disease (CSVD). It remains unknown whether EPVS are associated with hemorrhagic transformation (HT) after acute ischemic stroke (AIS). We performed this retrospective cohort study to explore the associations of EPVS with clinical risk factors and other CSVD imaging features, and to investigate the relationship between EPVS and HT in patients with AIS. METHODS: AIS patients admitted within 24 hours of stroke onset between January 2016 and December 2017 were consecutively enrolled. EPVS, lacunes, and white matter hyperintensities (WMH) were rated with validated rating scales on magnetic resonance images after the stroke. HT was defined as hemorrhage determined by follow-up brain imaging during the patients’ hospital stay. Logistic regression was used to determine the risk factors and associations with other CSVD markers of EPVS in the basal ganglia (BG) and centrum semiovale (CS) regions, and the impact of EPVS on HT was further explored. RESULTS: Among 494 included patients (mean age 66.4 years, 58.1% male), 81 (16.4%) experienced HT. In the multivariate logistic analyses, increasing age [odd ratio (OR) 1.041, 95% confidence interval (CI), 1.017–1.066], hypertension (OR 2.174, 95% CI, 1.338–3.532), lacunar stroke (OR 1.968, 95% CI, 1.169–3.314), CS-EPVS (OR 2.474, 95% CI, 1.796–3.407), and periventricular WMH (OR 2.140, 95% CI, 1.441–3.176) were significantly associated with BG-EPVS; whereas only BG-EPVS (OR 4.349, 95% CI, 2.281–8.291) were independently related to CS-EPVS. After adjustment for potential variables, neither BG-EPVS (OR 0.674, 95% CI, 0.336–1.350) nor CS-EPVS (OR 0.792, 95% CI, 0.334–1.879) was significantly associated with the occurrence of HT. CONCLUSIONS: Our data showed that EPVS in the BG and CS regions were interrelated and had different risk factors in ischemic stroke patients. EPVS (particularly that in BG) were independently related to other CSVD markers. The presence or burden of EPVS was not significantly associated with HT after AIS.