Systemic inflammation and cerebrovascular injury in acute stroke

Systemic inflammation contributes to cerebrovascular injury, yet cerebral small vessel disease and intracranial arterial calcification are typically evaluated separately. The aim of this study was to investigate the association between systemic inflammatory indices and the combined burden of small vessel disease and intracranial arterial calcification in acute ischemic stroke.

This retrospective study included 166 patients with acute anterior circulation ischemic stroke. Total small vessel disease burden (white matter hyperintensities, lacunes, cerebral microbleeds, and enlarged perivascular spaces) was assessed on magnetic resonance imaging. Intracranial arterial calcification severity was evaluated on non-contrast computed tomography using a semiquantitative grading system. Inflammatory indices, including neutrophil-to-lymphocyte ratio and systemic inflammatory response index, were calculated from baseline blood samples. Multivariate regression analyses were performed to identify independent predictors.

A total of 166 patients (mean age 64.5±9.8 years) were included. In multivariate analysis, the neutrophil-to-lymphocyte ratio was an independent predictor of both total small vessel disease burden (β=0.39, p=0.026) and intracranial arterial calcification severity (β=0.181, p=0.030), whereas the systemic inflammatory response index was not significant after adjustment. Additionally, the neutrophil-to-lymphocyte ratio was independently associated with cerebral microbleeds and hypertension, and platelet-related indices were associated with infarct size and enlarged perivascular spaces.

Neutrophil-to-lymphocyte ratio is independently associated with both microvascular and macrovascular cerebrovascular injury, supporting an inflammation-driven continuum. It may serve as a practical biomarker for assessing global cerebrovascular disease burden.