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Supplementary Material for: Association between perivascular spaces burden and future stroke risk in ischemic stroke and transient ischemic attack: A systematic review and meta-analysis

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posted on 2024-07-09, 06:29 authored by Lei H., Wu X., Ambler G., Werring D., Fang S., Lin H., Huang H., Liu N., Du H.
Introduction: This meta-analysis aimed to explore the association of perivascular spaces (PVS) burden with the risks of future stroke events and mortality in patients with ischemic stroke and transient ischemic attack (TIA). Methods: We systematically searched PubMed, Embase and Cochrane database from inception to 31 December 2023. We included eligible studies that reported adjusted estimated effects for future intracranial hemorrhage (ICH), ischemic stroke and mortality with baseline PVS burden in patients with ischemic stroke and TIA. Data were pooled using an inverse-variance method for fixed effect (FE) model and a restricted maximum likelihood (REML) method for random effects (RE) model. Results: Thirteen observational studies (5 prospective, 8 retrospective) were included, comprising 20256 patients. Compared to 0 - 10 PVS at basal ganglia (BG), a higher burden (>10) of BG-PVS was significantly associated with an increased risk of future intracranial hemorrhage (adjusted hazards ratio [aHR] 2.79, 95% confidence interval [CI] 1.16 - 6.73, RE model; aHR 2.14, 95%CI 1.34 - 3.41, FE model; I2 = 64%, n = 17084 from four studies) followed-up for at least one year. There was no significant association between >10 BG-PVS and intracranial hemorrhage within 7 days after reperfusion therapy (adjusted odds ratio [aOR] 1.69, 95%CI 0.74 - 3.88, RE model; aOR 1.43, 95%CI 0.89 - 2.88, FE model; I2 = 67%, n = 1176 from four studies). We did not detect a significant association of recurrent ischemic stroke, mortality or disability with BG-PVS burden. Neither >10 PVS at centrum semiovale (CSO-PVS) nor increasing CSO-PVS burden was significantly associated with the risk of future intracerebral hemorrhage or ischemic stroke recurrence. Conclusions: Current evidence suggests that a higher BG-PVS burden may be associated with an increased risk of future intracranial hemorrhage in patients with ischemic stroke and TIA. PROSPERO registration number: CRD42021232713 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021232713

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