Zhang Peiren, Luo Bin, Zhang Peilan, Yu Xiaoqing, Long Xiaoyue, Du Yuxuan, Tian Haozhi, Wang Liwen
Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Huanhu Hospital, Tianjin Medical University, Tianjin, China; Department of Emergency Medicine, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China.
Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Huanhu Hospital, Tianjin Medical University, Tianjin, China.
Am J Cardiol. 2025 Apr 1;240:76-81. doi: 10.1016/j.amjcard.2024.10.034. Epub 2024 Dec 20.
Individual cerebral small vessel disease (SVD) markers independently predict poor prognosis after 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 study evaluated the occurrence of SVD in patients with AIS who were treated with intravenous thrombolytic therapy using multimodal magnetic resonance imaging. The study involved patients with AIS who received multimodal magnetic resonance imaging scans before receiving intravenous thrombolytic treatment with recombinant tissue plasminogen activator (rt-PA). Validated scales were used to document each SVD characteristic and measure the overall impact of SVD using an extensive scoring method. Functional outcomes were evaluated using the modified Rankin scale score within a 3-month time frame, with poor outcomes categorized as a modified Rankin scale score of ≥2. Using a logistic regression model while accounting for potential confounding variables, we examined the relation among individual SVD characteristics, the overall SVD impact, and patient outcomes. In total, 282 patients were included. Severe white matter hyperintensities and lacunas were linked to negative clinical results in patients with SVD, even after accounting for age, National Institutes of Health Stroke Scale score at admission, onset to treatment time, and hypertension (odds ratio 2.394, 95% confidence interval 1.246 to 4.6; odds ratio 2.3, 95% confidence interval 1.214 to 4.36, respectively). When evaluating the 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 patients with ischemic stroke receiving intravenous rt-PA treatment. In conclusion, this information could be useful for predicting the prognosis of patients with stroke who underwent intravenous rt-PA therapy.
个体脑小血管病（SVD）标志物可独立预测卒中后的不良预后。然而，单一SVD，尤其是累积SVD负担，对静脉溶栓后急性缺血性卒中（AIS）结局的影响仍不明确。本研究使用多模态磁共振成像评估接受静脉溶栓治疗的AIS患者中SVD的发生情况。该研究纳入了在接受重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓治疗前接受多模态磁共振成像扫描的AIS患者。使用经过验证的量表记录每个SVD特征，并使用广泛的评分方法测量SVD的总体影响。在3个月时间范围内使用改良Rankin量表评分评估功能结局，不良结局定义为改良Rankin量表评分≥2分。在考虑潜在混杂变量的情况下，使用逻辑回归模型研究个体SVD特征、SVD总体影响与患者结局之间的关系。总共纳入了282例患者。即使在考虑年龄、入院时美国国立卫生研究院卒中量表评分、发病至治疗时间和高血压后，严重的白质高信号和腔隙与SVD患者的不良临床结果相关（优势比分别为2.394，95%置信区间1.246至4.6；优势比为2.3，95%置信区间1.214至4.36）。在评估SVD总体负担时，观察到SVD评分与不良临床结果之间存在强关联，但SVD评分为2分的病例除外。研究结果表明，预先存在的SVD，特别是以白质变化和腔隙的严重程度为特征，对接受静脉rt-PA治疗的缺血性卒中患者的临床结局有不利影响。总之，这些信息可能有助于预测接受静脉rt-PA治疗的卒中患者的预后。
