What is the significance of leukoaraiosis in patients with acute ischemic stroke?

Background: Leukoaraiosis (LA) may have specific clinical correlates in pat ients with stroke, but this is not well investigated, so that the significa nce of LA in patients with stroke remains unclear. Methods: In a study of 2289 patients with a first-ever acute ischemic strok e, LA was noted in 149 by the use of baseline computed tomography of the br ain. These patients were compared with the non-LA group. Statistical tests, including Fisher exact test or a chi(2) test, were used to compare variabl es, and a multivariate approach using stepwise logistic regression was perf ormed. Results: Patients with LA were significantly older (73.7 vs 62.7 years; P<. 001), and had a higher incidence of hypertension (72.5% vs 47.1%; P<.001) a nd subcortical or lacunar infarction (40.3% vs 25.4% and 21.5% vs 8.0%, res pectively; P<.001) on neuroimaging studies, compared with the non-LA group. The most common cause of stroke in the LA group was presumed to be small-a rtery disease associated with hypertension (46% vs 13.5% in the non-LA grou p). Age and hypertension were very strongly associated with LA (respective odds ratios [95% confidence intervals], 1.06 [1.04-1.08] and 2.33 [1.60-3.3 9]). In addition to these risk factors, a close relationship was found betw een LA and nonsevere stenosis (<50%) of the internal carotid artery (odds r atio, 2.23 [95% confidence interval, 1.32-3.76]), although the significance of this association remains speculative. The outcome at 1 month after stro ke was similar in both groups. Conclusion: Our results provide further evidence that LA is related primari ly to small-vessel disease.