Influence of cerebral small vessel disease overall burden on clinical outcome of acute stroke patients after intravenous thrombolysis / 中国脑血管病杂志

ABSTRACT

Objective To investigate the influence of cerebral small vessel disease(CSVD) overall burden on hemorrhagic transformation, stroke recurrence, and prognosis of stroke patients after intravenous thrombolysis. Methods From January 2017 to January 2019,175 consecutive stroke patients treated (within 4. 5 h of stroke onset) with intravenous thrombolysis using recombinant tissue plasminogen activator (rt-PA) at Department of Stroke Center, Affiliated Hospital of Southwest Medical University were enrolled retrospectively. Patient's general information and clinical features were recorded. Cranial MR examination was completed within 48 h of stroke onset and total MR CSVD score was used to evaluate the overall burden of CSVD of patients. According to scores, patients were divided into the CSVD 0-1 group and CSVD 2 - 4 group. Degree of neurologic impairment was assessed by National Institute of Health stoke scale (N1HSS) before and 24 h after thrombolysis. The modified Rankin scale (mRS) was used to evaluate the prognosis at 90 days after the stroke onset, and all patients were divided into the good prognosis group and the poor prognosis group. Clinical features between two groups were compared,and the prognosis of cerebral infarction 90days after rt-PA thrombolysis was observed. Results Among 175enrolled patients,91 were in the CSVD 0 - 1 group and 84 were in the CSVD 2 -4 group. Age ([63 ± 1 1 ] years vs. [71 ± 1 0 ] years,! = - 4 . 444, P <0. 01), previous stroke or transient ischemic attack (15. 4% [ 14/91 ] vs. 34. 5% [29/84] =8. 633, P =0. 003),infarction size (small size,medium size,and large size;41. 8% [38/91 ],27. 5% [25/91 ] and 30. 8% [28/91 ] vs. 29. 8% [ 25/84 ], 14. 3% [ 12/84], and 56. 0% [47/84 ], x2 = 11. 802, P = 0. 003), NIHSS score at admission (5 [ 3,9 ] vs. 9 [ 5, 14 ], 2 = - 4 . 169, P < 0. 01), hemorrhagic transformation (12. 1%[ 11/91] ra. 28. 6% [24/84], x2 =7. 418 ,P =0. 006),90d mRS score (1 [ 0, 3 ] vs. 3[ 1,5] ,Z = - 4 . 650 ,P <0. 01) were significantly different between the two groups. As for stroke recurrence rate within 3 months,the CSVD 0 - 1 group was lower than that of the CSVD 2 -4 group (5. 5% [5/91 ] f i . 11. 9% [10/84]),but without significant difference. Multivariate Logistic regression analysis revealed that high CSVD score (OR = \. 788,95% CI 1. 143 - 2 . 797,P =0. 011) was an independent risk factor for 90 d outcome of patients after intravenous thrombolysis. Conclusions Cerebral infarction patients with heavier overall burden of CSVD could have higher hemorrhagic transformation rate after venous thrombolysis and poorer 90 d-prognosis. The overall burden of CSVD was an independent risk factor for poor prognosis in stroke patients after intravenous thrombolysis.