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Published on: January 19, 2020
Cerebral small vessel disease impairs dynamic cerebral autoregulation and mediates outcomes after stroke thrombectomy
Yue Qiao1, Ran Liu2, Lupei Cai3
1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
Insights
Cerebral small vessel disease (CSVD) impacts outcomes after endovascular thrombectomy (EVT) by impairing dynamic cerebral autoregulation (dCA). Moderate-to-severe CSVD patients showed deteriorating dCA and worse functional independence post-EVT.
Area of Science:
- Neurology
- Vascular Medicine
- Medical Imaging
Background:
- Cerebral small vessel disease (CSVD) is linked to poor outcomes following endovascular thrombectomy (EVT).
- The mechanism by which CSVD affects EVT outcomes, specifically through dynamic cerebral autoregulation (dCA), remains unclear.
- Impaired dCA is a potential mediator between CSVD burden and functional outcomes post-EVT.
Purpose of the Study:
- To investigate if CSVD burden influences functional outcomes after EVT by altering dCA.
- To assess the relationship between CSVD severity and dCA recovery patterns.
- To determine the mediating role of dCA changes in the association between CSVD and functional independence.
Main Methods:
- An observational cohort study included 107 patients with anterior circulation large-vessel occlusion and successful EVT.
- CSVD burden was assessed using neuroimaging and dichotomized as none-to-mild vs. moderate-to-severe.
- dCA was measured at 24 hours (T1) and 4-5 days (T2) post-EVT, with mediation analysis performed.
Main Results:
- Moderate-to-severe CSVD patients (n=38) showed deteriorating dCA, while none-to-mild CSVD patients (n=69) showed improvement.
- Functional independence at 90 days was lower in moderate-to-severe CSVD patients (52.6%) vs. none-to-mild CSVD patients (73.9%).
- dCA changes, particularly in very low frequency (VLF) phase, mediated 24.48% of the association between CSVD burden and functional outcome.
Conclusions:
- Higher CSVD burden is associated with worse functional outcomes after EVT, partly mediated by impaired dCA.
- CSVD severity influences dCA recovery patterns post-EVT, with moderate-to-severe CSVD leading to deterioration.
- Further research is needed to validate these findings and explore underlying mechanisms.
Background:
Cerebral small vessel disease (CSVD) is associated with poor outcomes after endovascular thrombectomy (EVT), but the underlying mechanism remains unclear. Impaired dynamic cerebral autoregulation (dCA), a fundamental function of cerebral microvasculature, has been proposed as a potential mediator but has not been systematically investigated.
Objectives:
To determine whether CSVD burden influences functional outcomes through alterations in dCA.
Design:
Observational-cohort-study.
Methods:
We included 107 patients with anterior circulation large-vessel occlusion and successful EVT (expanded Thrombolysis in Cerebral Infarction ⩾2b). CSVD burden was assessed using standardised neuroimaging markers and dichotomised as none-to-mild (score 0-1) versus moderate-to-severe (score 2-3). dCA was assessed at two time points: early phase (T1, around 24 h post-EVT) and early subacute phase (T2, around 4-5 days post-EVT). Mediation analysis was performed to assess whether dCA changes mediated the association between CSVD burden and functional independence (modified Rankin Scale (mRS) score 0-2) at 90 days.
Results:
Patients with moderate-to-severe CSVD (n = 38) demonstrated distinct dCA recovery patterns compared with those with none-to-mild CSVD (n = 69). While patients with none-to-mild CSVD exhibited improved very low frequency (VLF, 0.02-0.07 Hz) phase differences from T1 to T2 (+7.67° (-9.73, 35.53)), those with moderate-to-severe CSVD exhibited deterioration (-7.17° (-25.03, -0.74), p = 0.004), which remained significant after multivariable adjustment (β = -20.06, 95% confidence interval (CI): -37.78 to -0.90, p = 0.040). Functional independence was achieved in 73.9% of patients with none-to-mild CSVD versus 52.6% in those with moderate-to-severe CSVD (adjusted OR 0.25, 95% CI 0.09-0.74, p = 0.012). Mediation analysis revealed that VLF phase changes in the affected side mediated 24.48% of the association between CSVD burden and functional outcome (average causal mediation effect: -7%, p < 0.001; total effect: -29%, p = 0.020).
Conclusion:
Higher CSVD burden was associated with worse functional outcomes after EVT, partially explained by impaired dCA. Patients with moderate-to-severe CSVD exhibited deteriorating dCA, whereas those with none-to-mild CSVD showed progressive improvement. Larger powerful studies are warranted to validate these findings and elucidate underlying mechanisms.
Trial Registration:
ClinicalTrials.gov, NCT06361017.
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