Risk factors for ischemic stroke: differences between cerebral small vessel and large artery atherosclerosis aetiologies

Folia Neuropathol. 2021;59(4):378-385. doi: 10.5114/fn.2021.112007.


The treatment for large artery atherosclerosis (LAA) stroke is also important for patients with cerebral small vessel disease (SVD). Our aim is to clarify the risk factors for ischemic cerebral SVD and to evaluate the different risk factor profiles of the two ischemic stroke subtypes, namely, ischemic cerebral SVD and LAA. A total of 353 patients with acute ischemic stroke were assigned to two groups according to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria: the ischemic cerebral SVD group and the LAA group. A total of 70 non-stroke patients admitted during the same period served as the control group. Clinical variables were collected, including age, sex, blood pressure, blood glucose, triglycerides, low-density lipoprotein, total cholesterol (TC), smoking history, drinking history, coronary atherosclerotic heart disease and family history of a high-risk disease. Multivariate logistic regression (MLR) analyses were performed. MLR analysis showed that risk factors for LAA stroke included hypertension, diabetes mellitus, high low-density lipoprotein, hypertriglyceridemia and smoking compared with the control group. The analysis also showed that the risk factors for cerebral SVD stroke were hypertension, diabetes mellitus, high TC, hypertriglyceridemia and smoking. In terms of the factors distinguishing LAA and cerebral SVD, MLR demonstrated that high TC played prominent roles in cerebral SVD. Hypertension, diabetes mellitus, high total cholesterol, hypertriglyceridemia and smoking are independent risk factors for cerebral SVD stroke. Compared with the LAA stroke group, patients with cerebral SVD stroke were more likely to have a high level of TC.

Keywords: large artery atherosclerosis; white matter lesions; cerebral small vessel disease.

Publication types

  • Controlled Clinical Trial

MeSH terms

  • Arteries
  • Atherosclerosis* / complications
  • Brain Ischemia* / complications
  • Humans
  • Ischemic Stroke*
  • Risk Factors
  • Stroke* / etiology