CEREBRAL MICROANGIOPATHY BY MRI DATA: PREDICTION OF COGNITIVE IMPAIRMENTS AND RISK OF RECURRENT VASCULAR EVENTS IN THE LONG-TERM PERIOD OF ISCHEMIC STROKE (LITERATURE REVIEW)

Аннотация

Objective: To systematize data on the role of MRI-detected markers of cerebral microangiopathy (CMA) in predicting cognitive impairment and risk of recurrent vascular events in patients during the long-term period after ischemic stroke. Materials and Methods: Analyzed 33 publications (2015–2025) on CMA pathogenesis, validation of MRI markers (lacunar infarcts, white matter hyperintensity, microbleeds, atrophy), and their prognostic significance. Focus on the "CMA burden" concept and advanced MRI techniques (DTI, blood-brain barrier permeability assessment). Results: CMA is an independent predictor of adverse outcomes: "CMA burden" increases vascular dementia risk 3.5–4.2-fold and recurrent vascular events risk 3.2-fold. Key MRI markers for cognitive impairment risk: white matter hyperintensity volume >10 cm³ (OR 3.5), lacunar infarcts >3 (OR 4.0), multiple microbleeds (>5, OR 1.6). For recurrence prediction, the SVDss scale (AUC 0.78) and lobar microbleeds (hemorrhagic stroke risk up to 15%/year) are significant. Advanced MRI techniques detect preclinical CMA stages: reduced frontal lobe fractional anisotropy precedes cognitive decline by 2–3 years. Conclusion: MRI markers of CMA are critically important for risk stratification. Incorporating "CMA burden" assessment (SVDss scale) into patient management algorithms is recommended. Personalized secondary prevention (BP control <130/80 mmHg, differentiated antithrombotic therapy) and early neuroprotection improve long-term outcomes.