Impact of Small Vessel Disease on Patient Outcomes Following Intravenous Thrombolysis For Acute Ischemic Stroke

Peiren Zhang; Bin Luo; Peilan Zhang; Xiaoqing Yu; Xiaoyue Long; Yuxuan Du; Haozhi Tian; Liwen Wang

doi:10.1016/j.amjcard.2024.10.034

Impact of Small Vessel Disease on Patient Outcomes Following Intravenous Thrombolysis For Acute Ischemic Stroke

Am J Cardiol. 2024 Dec 20:S0002-9149(24)00774-4. doi: 10.1016/j.amjcard.2024.10.034. Online ahead of print.

Authors

Peiren Zhang¹, Bin Luo², Peilan Zhang³, Xiaoqing Yu⁴, Xiaoyue Long⁴, Yuxuan Du⁴, Haozhi Tian⁴, Liwen Wang⁵

Affiliations

¹ Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, 403, Block D, Huanhu Hospital, Jizhao Road, Jinnan District, Tianjin 300222; Department of Emergency Medicine, Affiliated Hospital of Inner Mongolia Medical University, No. 1 North Channel Street, Huimin District, Hohhot, Inner Mongolia Autonomous Region, China. 010010.
² Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, No.15, Yuquan Road, Haidian District, Beijing, Aerospace Center Hospital, Department of Neurology, 100049.
³ Department of Neurology, Tianjin Huanhu Hospital, 6 Jizhao Road, Jinnan District 300222. Electronic address: peilanzhng@sina.com.
⁴ Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, 403, Block D, Huanhu Hospital, Jizhao Road, Jinnan District, Tianjin 300222.
⁵ Jinan Hospital, 63-1 Lishan Road, Jinan City 250013.

PMID: 39710355
DOI: 10.1016/j.amjcard.2024.10.034

Abstract

Individual cerebral small vessel disease (SVD) markers independently predict poor prognosis following stroke. However, the impact of a single SVD, especially cumulative SVD burden on outcomes in acute ischemic stroke (AIS) after intravenous thrombolysis remains unclear. This work evaluated the occurrence of small vessel disease (SVD) in AIS patients who were treated with intravenous thrombolytic therapy by using multimodal MRI imaging. The study involved AIS patients who received multimodal MRI scans before receiving intravenous thrombolytic treatment with rt-PA. Validated scales were utilized to document each small vessel disease characteristic and measure the overall impact of SVD using an extensive scoring method. Functional outcomes were evaluated using the modified Rankin scale (mRS) score within a 3-month time-frame, with poor outcomes categorized as an mRS score of ≥2. Utilizing a logistic regression model while accounting for potential confounding variables, we examined the relationship between individual SVD characteristics, the overall SVD impact, and patient outcomes. In total, 282 patients were included. Severe white matter hyperintensities (WMH) and lacunas were linked to negative clinical results in SVD patients, even after accounting for age, NIHSS score at admission, onset to treatment time (OTT), and hypertension (OR 2.394, 95% CI 1.246-4.6 and OR 2.3, 95% CI 1.214-4.36, respectively). When evaluating SVD global burden, a strong association between the SVD score and negative clinical results was observed, except for cases with an SVD score of 2 points. The findings suggest that the presence of pre-existing SVD, particularly characterized by the severity of white matter changes and lacunes, has a detrimental impact on the clinical outcomes of ischemic stroke patients receiving IV rt-PA treatment. In conclusion, this information could be useful for predicting the prognosis of stroke patients undergoing IV rt-PA therapy.

Keywords: cerebral small vessel disease; ischemic stroke; lacunes; microbleeds; perivascular spaces; thrombolysis; white matter hyperintensities.