Department of Neurology, Bethune International Peace Hospital, Shijiazhuang, Hebei, China.
Department of Gastroenterology, Bethune International Peace Hospital, Shijiazhuang, Hebei, China.
J Clin Neurosci. 2024 May;123:179-185. doi: 10.1016/j.jocn.2024.04.003. Epub 2024 Apr 6.
Cerebral small vessel disease (CSVD) is prevalent in the population, especially among the elderly. Various types of CSVD markers commonly coexist, and the neurological function outcome is affected by their combined effect. Studies investigating the association between total CSVD burden and stroke outcomes in large vessel occlusion (LVO) stroke receiving endovascular treatment (EVT) are expanding but have not been systematically assessed.
We systematically searched the PubMed, Embase, and Cochrane databases for relevant clinical studies. The total CSVD burden score summarized the markers of CSVD, including lacunes, white matter hyperintensities (WMHs), cerebral microbleeds (CMBs), and enlarged perivascular spaces (EPVSs), which was a comprehensive index of overall CSVD burden. The pooled odds ratios (ORs) were used to calculate the association between high total CSVD burden score and outcomes of EVT in patients with LVO stroke. The primary outcome was poor functional outcome, which was defined as a modified Rankin Scale score (mRS) ≥ 3 at 90 days after EVT. The secondary outcomes were symptomatic intracranial hemorrhage (sICH) and poor collateral flow.
Overall, 6 eligible studies with 1,774 patients with LVO stroke undergoing EVT were pooled in meta-analysis. High overall CSVD burden score was significantly associated with increased risks of poor functional outcome at 90 days (pooled OR 2.86, 95 % CI 1.31-6.25, p = 0.008). Besides, high overall CSVD burden score was associated with sICH (pooled OR 2.07, 95 % CI 0.38-5.17; p = 0.118) and poor collateral flow (pooled OR 1.57, 95 % CI 0.75-3.27; p = 0.232), but were not statistically significant.
High overall CSVD burden was associated with increased risks of unfavorable outcomes in patients with LVO stroke undergoing EVT.
脑小血管病（CSVD）在人群中很常见，尤其是老年人。各种类型的 CSVD 标志物通常共存，神经功能的结果受其共同作用的影响。研究表明，接受血管内治疗（EVT）的大血管闭塞（LVO）卒中患者的总 CSVD 负担与卒中结局之间存在关联，但这些研究仍在不断扩展，尚未进行系统评估。
我们系统地检索了 PubMed、Embase 和 Cochrane 数据库中相关的临床研究。总 CSVD 负担评分总结了 CSVD 的标志物，包括腔隙、脑白质高信号（WMHs）、脑微出血（CMBs）和扩大的血管周围间隙（EPVSs），这是总 CSVD 负担的综合指标。采用汇总优势比（OR）计算 LVO 卒中接受 EVT 患者中高总 CSVD 负担评分与 EVT 结局之间的关联。主要结局是功能不良结局，定义为 EVT 后 90 天改良Rankin 量表评分（mRS）≥3 分。次要结局是症状性颅内出血（sICH）和较差的侧支循环。
总体而言，纳入了 6 项研究，共纳入 1774 例接受 EVT 的 LVO 卒中患者，进行了荟萃分析。高总 CSVD 负担评分与 90 天的不良功能结局风险增加显著相关（汇总 OR 2.86，95%CI 1.31-6.25，p=0.008）。此外，高总 CSVD 负担评分与 sICH（汇总 OR 2.07，95%CI 0.38-5.17；p=0.118）和较差的侧支循环（汇总 OR 1.57，95%CI 0.75-3.27；p=0.232）相关，但无统计学意义。
高总 CSVD 负担与接受 EVT 的 LVO 卒中患者不良结局风险增加相关。
