Higher basal ganglia-enlarged perivascular space burdens are associated with higher risks of ischemic stroke and major bleeding in patients receiving antithrombotic therapy, suggesting BGPVSs may serve as useful imaging biomarkers for vascular risk assessment and personalized therapy.
Key Findings
Results
Higher BGPVS burden was associated with an increased risk of major bleeding in patients taking antithrombotic therapy.
BGPVS ≥21 was associated with an adjusted hazard ratio of 4.04 (95% CI 1.17–13.92) for major bleeding compared to reference category.
Per-unit increase in BGPVS category was associated with an aHR of 1.38 (95% CI 1.07–1.77) for major bleeding.
Over the study period, 92 major bleeding events were observed.
Analysis used multivariable Cox proportional hazards models adjusted for patient demographics, vascular risk factors, and other SVD markers.
Results
Higher BGPVS burden was associated with an increased risk of ischemic stroke in patients taking antithrombotic therapy.
BGPVS ≥21 was associated with an aHR of 2.58 (95% CI 1.21–5.50) for ischemic stroke.
Per-unit increase in BGPVS category was associated with an aHR of 1.28 (95% CI 1.07–1.53) for ischemic stroke.
188 ischemic stroke events were observed over the median follow-up of 2.0 years.
BGPVSs were categorized as 0, 1–10, 11–20, or ≥21 based on centrally evaluated baseline MRI.
Results
Higher BGPVS burden was not significantly associated with intracranial hemorrhage, overall ischemic events, or mortality.
54 intracranial hemorrhage events, 266 ischemic events, and 198 deaths occurred during follow-up.
Despite the association with major bleeding, the specific outcome of intracranial hemorrhage did not reach statistical significance with higher BGPVS.
Overall ischemic events (as distinct from ischemic stroke specifically) also did not show a significant association with BGPVS burden.
Mortality was similarly not significantly associated with higher BGPVS categories.
Methods
The study enrolled 5,065 patients on antithrombotic therapy with a distribution of BGPVS categories showing the majority had 1–10 perivascular spaces.
Total cohort: 5,065 patients (1,663 women; median age 74, IQR 67–81 years) enrolled at 52 hospitals across Japan between 2016 and 2019.
BGPVS distributions: 0 in 475 (9.4%), 1–10 in 2,615 (51.6%), 11–20 in 1,267 (25.0%), and ≥21 in 708 (14.0%) patients.
Antiplatelets were administered to 3,820 (75.4%) patients and anticoagulants to 1,502 (29.7%) patients at baseline.
Median follow-up was 2.0 years (IQR 1.8–2.0).
Baseline multimodal MRI was centrally evaluated for SVD markers including white matter hyperintensities, cerebral microbleeds, lacunes, and BGPVSs.
Methods
Enlarged perivascular spaces in the basal ganglia were assessed as part of a broader cerebral small vessel disease imaging evaluation in a prospective multicenter cohort.
This was a prospective, multicenter observational study conducted at 52 hospitals across Japan.
Baseline multimodal MRI was performed for all participants and centrally evaluated.
SVD markers assessed included white matter hyperintensities, cerebral microbleeds, lacunes, and basal ganglia-enlarged perivascular spaces.
The study focused on patients with cerebrovascular or cardiovascular diseases who had newly started or were continuing oral antithrombotic agents.
Iwamoto S, Miwa K, Koga M, Yoshimura S, Tanaka K, Yakushiji Y, et al.. (2026). Impact of Basal Ganglia Perivascular Spaces on Ischemic and Hemorrhagic Risks in Patients Taking Antithrombotic Therapies.. Neurology. https://doi.org/10.1212/WNL.0000000000214745