Zhao Yixin, Ning Yuye, Lei Lei, Yuan Huijie, Liu Hui, Luo Guogang, Wei Meng, Li Yongxin
Stroke Centre, Department of Neurology, The First Affiliated Hospital of the Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an 710061, China.
Department of Medical Imaging, The First Affiliated Hospital of the Xi'an Jiaotong University, Xi'an 710061, China.
J Clin Med. 2022 Nov 22;11(23):6883. doi: 10.3390/jcm11236883.
The correlation between cerebral small vessel disease (CSVD) and the outcomes of acute ischemic stroke (AIS) patients after endovascular therapy (EVT) remains elusive. We aimed to investigate the effect of combined white matter hyperintensities (WMH) and enlarged perivascular spaces (EPVS) as detected in magnetic resonance imaging (MRI) at baseline on clinical outcomes in patients with AIS who underwent EVT. AIS patients that experienced EVT were retrospectively analyzed in this single-center study. Using MRIs taken prior to EVT, we rated WMH and EPVS as the burden of CSVD and dichotomized the population into two groups: absent-to-moderate and severe. Neurological outcome was assessed at day 90 with a modified Rankin Scale (mRS). Symptomatic intracerebral hemorrhage (sICH), early neurological deterioration (END), malignant cerebral edema (MCE), and hospital death were secondary outcomes. Of the 100 patients (64.0% male; mean age 63.71 ± 11.79 years), periventricular WMHs (28%), deep WMHs (41%), EPVS in basal ganglia (53%), and EPVS in centrum semiovale (73%) were observed. In addition, 69% had an absent-to-moderate total CSVD burden and 31.0% had a severe burden. The severe CSVD was not substantially linked to either the primary or secondary outcomes. Patients with AIS who underwent EVT had an elevated risk (OR: 7.89, 95% CI: 1.0, 62.53) of END if they also had EPVS. When considering WMH and EPVS together as a CSVD burden, there seemed to be no correlation between severe CSVD burden and sICH, END, or MCE following EVT for AIS patients. Further studies are warranted to clarify the relationship between CSVD burden and the occurrence, progression, and prognosis of AIS.
脑小血管病（CSVD）与急性缺血性卒中（AIS）患者血管内治疗（EVT）后的预后之间的相关性仍不明确。我们旨在研究在基线磁共振成像（MRI）中检测到的白质高信号（WMH）和血管周围间隙扩大（EPVS）相结合对接受EVT的AIS患者临床预后的影响。在这项单中心研究中，对接受EVT的AIS患者进行了回顾性分析。利用EVT前拍摄的MRI，我们将WMH和EPVS评定为CSVD的负担，并将研究人群分为两组：轻度至中度和重度。在第90天用改良Rankin量表（mRS）评估神经功能预后。症状性脑出血（sICH）、早期神经功能恶化（END）、恶性脑水肿（MCE）和医院死亡为次要预后指标。100例患者（男性占64.0%；平均年龄63.71±11.79岁）中，观察到脑室周围WMH（28%）、深部WMH（41%）、基底节区EPVS（53%）和半卵圆中心EPVS（73%）。此外，69%的患者CSVD总负担为轻度至中度，31.0%的患者负担严重。严重CSVD与主要或次要预后指标均无显著关联。接受EVT的AIS患者若同时存在EPVS，则发生END的风险升高（OR：7.89，95%CI：1.0，62.53）。当将WMH和EPVS一起视为CSVD负担时，对于AIS患者，严重CSVD负担与EVT后的sICH、END或MCE之间似乎没有相关性。有必要进行进一步研究以阐明CSVD负担与AIS的发生、进展及预后之间的关系。
