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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Total Cerebral Small Vessel Disease Burden Predicts the Outcome of Acute Stroke Patients after Intra-Arterial
Mengqi Yang1, Jiahui Liang2, Baohui Weng1
1Department of Neurology and Stroke Center, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China.
Insights
A combined measure of cerebral small vessel disease (cSVD) burden predicts outcomes in acute ischemic stroke (AIS) patients undergoing intra-arterial thrombectomy (IAT). Higher cSVD burden correlates with poorer neurological function after IAT.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Research
Background:
- Cerebral small vessel diseases (cSVD) markers often coexist and impact neurological outcomes.
- The combined effect of multiple cSVD markers on treatment efficacy is not fully understood.
- Intra-arterial thrombectomy (IAT) is a critical treatment for acute ischemic stroke (AIS).
Purpose of the Study:
- To develop and validate a model assessing the total cSVD burden.
- To investigate the predictive value of this total cSVD burden for AIS patient outcomes after IAT.
- To determine if combined cSVD markers improve outcome prediction compared to individual markers.
Main Methods:
- Retrospective analysis of 271 AIS patients treated with IAT (October 2018 - March 2021).
- Calculation of multiple cSVD markers using magnetic resonance imaging.
- Assessment of modified Rankin Scale (mRS) scores at 90 days and logistic regression analysis.
Main Results:
- Higher total cSVD burden was significantly associated with poor neurological outcomes (mRS 3-5).
- A predictive model incorporating total cSVD burden, age, onset-to-reperfusion time, ASPECTS, NIHSS, and mTICI achieved high predictive accuracy (AUC 0.90).
- Excluding total cSVD burden from the model significantly reduced its predictive capability (AUC 0.82, p=0.045).
Conclusions:
- Total cSVD burden is an independent predictor of clinical outcomes in AIS patients following IAT.
- Integrating total cSVD burden into predictive models enhances the accuracy of forecasting post-IAT outcomes.
- This comprehensive assessment of cSVD may guide treatment decisions and prognostication for AIS patients.
Introduction:
Various types of cerebral small vessel diseases (cSVD) markers commonly coexist. The neurological function outcome is affected by their combined effect. To investigate the effect of cSVD on intra-arterial thrombectomy (IAT), our study aimed at developing and testing a model with fusing a combination of multiple cSVD markers as total cSVD burden to predict the outcome of acute ischemic stroke (AIS) patients after IAT treatment.
Methods:
From October 2018 to March 2021, continuous AIS patients with IAT treatment were enrolled. We calculated the cSVD markers identified by magnetic resonance imaging. The outcomes of all patients were assessed according to the modified Rankin Scale (mRS) score at 90 days after stroke. The relationship between total cSVD burden and outcomes was analyzed by logistics regression analysis.
Results:
A total of 271 AIS patients were included in this study. The proportions of score 0∼4 in the total cSVD burden group (i.e., score 0, 1, 2, 3, and 4 groups) were 9.6%, 19.9%, 23.6%, 32.8%, and 14.0%, respectively. The higher the cSVD score, the more patients with a poor outcome. Heavier total cSVD burden (1.6 [1.01∼2.27]), diabetes mellitus (1.27 [0.28∼2.23]), and higher national institute of health stroke scale (NIHSS) on admission (0.15 [0.07∼0.23]) were associated with poor outcome. In the two Least Absolute Shrinkage and Selection Operator regression models, model 1 using age, duration from onset to reperfusion, Alberta stroke program early CT score (ASPECTS), NIHSS on admission, modified thrombolysis in cerebral infarction (mTICI) and total cSVD burden as variables perform well on predicting short-term outcome in area under curve (AUC) of 0.90. Model 2, including all of the variables above except cSVD, showed less predictive capability than model 1 (AUC 0.90 vs. 0.82, p = 0.045).
Conclusions:
The total cSVD burden score was independently associated with the clinical outcomes of AIS patients after IAT treatment and it may be a reliable predictor for poor outcomes of AIS patients after IAT treatment.
