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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Cerebral Small Vessel Diseases and Outcomes for Acute Ischemic Stroke Patients after Endovascular Therapy

Yixin Zhao1, Yuye Ning1, Lei Lei1

  • 1Stroke Centre, Department of Neurology, The First Affiliated Hospital of the Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an 710061, China.

Journal of Clinical Medicine
|December 11, 2022
PubMed

Insights

Cerebral small vessel disease burden did not significantly impact outcomes for acute ischemic stroke patients undergoing endovascular therapy. However, enlarged perivascular spaces alone increased the risk of early neurological deterioration.

Area of Science:

  • Neurology
  • Radiology
  • Cardiovascular Research

Background:

  • Cerebral small vessel disease (CSVD) is common in acute ischemic stroke (AIS) patients.
  • The impact of combined white matter hyperintensities (WMH) and enlarged perivascular spaces (EPVS) on AIS outcomes after endovascular therapy (EVT) is not well understood.

Purpose of the Study:

  • To investigate the association between baseline CSVD burden (WMH and EPVS) and clinical outcomes in AIS patients treated with EVT.
  • To determine if severe CSVD predicts poor outcomes, including neurological function, symptomatic intracerebral hemorrhage, early neurological deterioration, malignant cerebral edema, and hospital death.

Main Methods:

  • Retrospective analysis of 100 AIS patients who underwent EVT.
  • MRI assessment of WMH and EPVS to quantify CSVD burden (absent-to-moderate vs. severe).
  • Clinical outcomes assessed at 90 days using modified Rankin Scale (mRS); secondary outcomes included sICH, END, MCE, and hospital death.

Main Results:

  • Severe CSVD burden was not significantly associated with primary or secondary outcomes.
  • Patients with AIS undergoing EVT had a higher risk of early neurological deterioration (END) if they had enlarged perivascular spaces (EPVS).
  • No correlation was found between severe combined CSVD burden and sICH, END, or MCE after EVT.

Conclusions:

  • Baseline CSVD burden, assessed by combined WMH and EPVS, does not appear to significantly influence outcomes in AIS patients treated with EVT.
  • Enlarged perivascular spaces (EPVS) alone may be a risk factor for early neurological deterioration in AIS patients undergoing EVT.
  • Further research is needed to fully elucidate the complex relationship between CSVD and AIS prognosis.

Keywords:
acute ischemic strokecerebral small vessel diseasesendovascular therapymagnetic resonance imagingoutcome

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