Abstract WP129: Assessing Post-Stroke Outcomes as a Function of White Matter Hyperintensity Burden in the Minor Acute Ischemic Stroke Population (TIMES-2 Study)

Introduction: Minor stroke can impact return to prior function, cognitive status, mood. Preexisting white matter hyperintensities (WMH) are common in stroke patients and may explain outcome differences among minor acute ischemic stroke (mAIS) patients. The study examined the association between WMH and early (30 and 90 day) post-stroke outcomes in mAIS patients. Methods: Patients with MRI-confirmed mAIS (NIHSS<6) within 24 hours of symptom onset presenting to Suburban Hospital (MD) or Washington Hospital Center (DC) were enrolled in the Treatment of Minor Stroke with MRI Evaluation Study (TIMES-2) and underwent serial MRI and clinical assessment up to 90 days. Patients with non-evaluable MRI for WMH volume or with missing covariates were excluded. WMH burden was quantified from baseline FLAIR sequences and normalized for total intracranial volume. Outcomes included the modified Rankin scale (mRS), Montreal Cognitive Assessment (MoCA), and Center for Epidemiological Studies Depression Scale (CES-D). Associations between WMH (in quartiles and continuously after log transformation and standardization) and outcomes at 30 and 90 days were evaluated using linear (MoCA) and logistic regressions (mRS≥2; CES-D≥16), adjusting for demographics, vascular risk factors, and admission NIHSS in sensitivity analyses. Stratified analyses by sex and thrombolytic treatment were conducted to evaluate effect modification. Results: Among 159 patients included (mean age 66.2 y, 36% non-Hispanic Black, and 40% female), WMH burden was not associated with 30-day MoCA. Greater WMH was associated with lower 90-day MoCA scores (n=109), both continuously (β -0.98; 95%CI: -1.58, -0.39) and in quartiles (Q4 vs. Q1: β -2.60, 95%CI -4.13, -1.06). Results were similar after adjustment for admission NIHSS. The association between continuous WMH burden and lower 90-day MoCA was greater in men (β -1.34; 95%CI: -2.16, -0.52) compared to women (β -0.34; 95%CI -1.28, 0.60) (p-interaction<0.05). Thrombolysis-treated patients showed a stronger but nonsignificant association between WMH and MoCA vs untreated patients. No significant association was found between WMH and functional disability or depression. Conclusions: Greater WMH burden is associated with worse cognitive performance at 90 days in patients with mAIS. This association is more evident in men. These findings highlight the importance of considering WMH burden when planning follow-up care and evaluating prognosis in patients with mAIS.