Best, Jonathan Gordon; (2024) Imaging biomarkers in the secondary prevention of stroke. Doctoral thesis (Ph.D), UCL (University College London).

Text Imaging Biomarkers in the Secondary Prevention of Stroke.pdf - Other Access restricted to UCL open access staff until 1 April 2025. Download (5MB)

Abstract

This thesis aims to contribute to the secondary prevention of stroke through the identification and improved understanding of neuroimaging biomarkers of cerebrovascular disease. The first section of the thesis describes the development of novel clinico-radiological risk scores for the prediction of intracranial haemorrhage and ischaemic stroke in patients taking antithrombotics after ischaemic stroke or transient ischaemic attack, based on cerebral microbleeds, a magnetic resonance imaging marker of vascular fragility and cerebral small vessel disease. The second section investigates the prognostic significance of magnetic resonance imaging-visible (enlarged) perivascular spaces, an emerging biomarker of cerebral small vessel disease, initially in a multicentre prospective cohort study of patients with atrial fibrillation prescribed anticoagulants for secondary prevention of stroke, then in a much larger international individual patient data meta-analysis of patients with previous ischaemic stroke or transient ischaemic attack of any cause. The performance of composite cerebral small vessel disease rating scales intended to summarise the total radiological burden of small vessel disease is also explored. The third section focuses on atrial fibrillation, an important cause of ischaemic stroke and the main indication for the use of oral anticoagulation for the secondary prevention of stroke. A cross-sectional design is used to compare the imaging phenotypes of ischaemic stroke patients with and without a diagnosis of atrial fibrillation at hyperacute stroke unit discharge, and, in a separate study, the clinical and imaging features of patients with atrial fibrillation known before stroke and those with atrial fibrillation diagnosed after stroke (hypothesised to be neurogenic in some cases). The final section of the thesis presents the trial protocol summary and neuroimaging analysis plan, developed by the candidate, for OPTIMAS, an ongoing multicentre randomised controlled trial of the timing of anticoagulation initiation after atrial fibrillation-associated ischaemic stroke.

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