論文種別	原著(症例報告除く)
言語種別	英語
査読の有無	その他(不明)
表題	Impact of Cerebral Small Vessel Disease on Functional Decline: Bleeding With Antithrombotic Therapy 2 Study.
掲載誌名	正式名：Stroke 略　 称：Stroke ISSNコード：15244628/00392499
掲載区分	国外
巻・号・頁	57(7),pp.2065-2075
著者・共著者	Yoshito Arakaki, Kaori Miwa, Masatoshi Koga, Sohei Yoshimura, Kanta Tanaka, Jin Nakahara, Yusuke Yakushiji, Makoto Sasaki, Shigeru Fujimoto, Masayuki Shiozawa, Satoshi Okuda, Toru Iwama, Masafumi Ihara, Kazutoshi Nishiyama, Teruyuki Hirano, Kazunori Toyoda,
発行年月	2026/07
概要	BACKGROUND:To what extent cerebral small vessel disease (SVD) contributes to functional disability remains unclear. We investigated the longitudinal effect of SVD burden on functional decline.METHODS:In this investigator-initiated, prospective, multicenter, and observational study, patients receiving oral antithrombotic therapy for cerebrovascular or cardiovascular diseases were enrolled from 52 hospitals across Japan (2016-2019) and followed for 24 months. SVD score (range, 0-4) was calculated on baseline magnetic resonance imaging obtained under prespecified conditions. The outcomes were an increase in modified Rankin Scale (mRS) score from baseline to end of follow-up (ΔmRS score ≥1). Logistic regression evaluated the association between ΔmRS score ≥1 and SVD score, adjusting for age, sex, premorbid mRS, vascular risk factors, antithrombotic therapy, magnetic resonance imaging field strength, and bleeding or ischemic events during follow-up. Bleeding and ischemic events were treated as time-dependent covariates. Causal mediation analyses using a 4-way decomposition separated the effects of SVD score ≥3 on ΔmRS score ≥1 into direct and indirect effects (mediated by major bleeding or ischemic events).RESULTS:Of 5378 patients enrolled, 613 were excluded mainly due to the lack of clinical or imaging data. Finally, 4765 patients were analyzed (1573 women; median age, 73 years); ΔmRS score ≥1 was observed in 13.2% of patients with SVD score 0, 16.1% with 1, 20.7% with 2, 28.1% with 3, and 28.2% with 4. SVD score of 3 (adjusted odds ratio, 1.65 [95% CI, 1.27-2.15]) and SVD score of 4 (1.62 [95% CI, 1.19-2.19]) were associated with ΔmRS score ≥1 compared with SVD score of 0. Causal mediation analysis indicated that 73.05% of the total effect of SVD score ≥3 on ΔmRS score ≥1 was attributed to the controlled direct effect (coefficient, 0.497 [95% CI, 0.26-0.73]).CONCLUSIONS:SVD burden was associated with functional decline beyond significant bleeding or ischemic events.
DOI	10.1161/STROKEAHA.125.054738
PMID	42220244