Correlation Analysis Of The Global Burden Of Cerebral Small Vessel Disease With The Hemorrhagic Transformation And Clinical Outcomes Of Acute Ischemic Stroke After ? Rt-PA Treatment

Objective:The present study was designed to investigate the relationship between the total cerebral small vessel disease(CSVD)burden and intracranial hemorrhage transformation(HT),clinical outcome of acute ischemic stroke(AIS)after recombinant tissue plasminogen activator(rt-PA)treatment.Methods:Two hundred and eighteen patients who received intravenous thrombolysis with recombinant tissue plasminogen activator(rt-PA)in our green channel of emergency stroke from August 2016 to July 2018 were collected.The MR examination was completed within 48 hours after thrombolysis.According to the total burden rating scale of CSVD,a point was awarded for each of the following:One point was awarded on the CSVD scale when(early)confluent deep WMHs(Fazekas score 2 or 3)and/or irregular periventricularWMHs extending into the deep white matter(Fazekas score 3)were present,the presence of one or more CMBs was given one point on the CSVD scale,presence of PVS was counted if there were moderate to severe(grade 2-4)PVS in the basal ganglia,one point on the CSVD scale was awarded when one or more LI were present,We therefore combined the scores of WMHs,CMBs,PVS,and LI We therefore combined the scores of WMHs,CMBs,PVS,and LI.The patients were divided into two groups according to whether they occurred with HT.The baseline data,clinical data and the total CSVD score were compared between the two groups.The multivariate logistic regression method was used to analyze the relationship between the global burden of CSVD and HTof AIS after intravenous(IV)rt-PA treatment.All patients were assessed with the mRS score at 90 days.We used multivariate logistic regression analysis to examine the associations between global burden of CSVD score and clinical prognosis.ROC curve analysis was used to determine cut-off values of the total CSVD score in predicting poor prognosis.Results:1.General clinical characteristics of the study population218 patients with acute ischemic stroke who received ? rt-PA treatment were included in the study.The average age was 66 years(65.79 ± 11.99 years),and males were 144(66.1%).The total CSVD score:48 cases(22%)were 0 points,77 cases(35.3%)were 1 point,54 cases(24.8%)were 2 points,29 cases(13.3%)were 3 points,and 10 cases(4.6%))is 4 points.Patients with increased CSVD scores were older(P<0.001),with higher diastolic blood pressure(P<0.05),and more likely to have hypertension(P<0.001)and cardiac insufficiency(P<0.05).2.Single factor and multivariate logistic regression analysis of hemorrhagic transformationOf the 218 patients with AIS who received IV rt-PA,32(14.7%)had HT,of which 15(6.9%)were symptomatic intracranial hemorrhage.The patients who were with advanced age,longer OTT time,lower international standardized prothrombin ratio,prolonged prothrombin time,previous history with hypertension,atrial fibrillation or cardiac insufficiency,CSVD on MR imaging were more likely to have HT complications.Multivariate logistic regression analysis showed only baseline diastolic blood pressure(OR=1.062,95%CI=1.028-1.097,P<0.001),atrial fibrillation(OR=13.039,95%CI=3.545-47.963,P<0.001),CRP(OR=1.077,95%CI=1.012-1.145,P=0.019)were still independently associated with HT.We defined mild CSVD as the reference value,moderate CSVD was not associated with HT(OR=2.366,95%CI=0.612-9.154,P=0.212),and severe CSVD was independently associated with HT(OR=18.044,95%CI=5.064-64.301),P<0.001).2.Univariable and multivariable regression analyses of functional outcomes at 3 monthsAfter 3 months of follow up,96(44%)patients had poor prognosis.Patients with poor prognosis commonly had older age,severe stroke,high baseline diastolic blood pressure,high blood glucose,high infarct volumes,high CRP,previous history of hypertension,previous history of atrial fibrillation,CSVD on MR imaging,and higher total CSVD score.After multivariate adjustment,the results showed that only baseline NIHSS(OR=1.233,95%CI=1.144-1.330,P<0.001),OTT(OR=1.007,95%CI=1.000-1.014,P=0.037)and the total CSVD score(OR=3.157,95%CI=2.120-4.703,P<0.001)were significantly associated with poor neurological prognosis at 3 months of discharge.The total CSVD score was independently associated with the 3-month clinical prognosis of AIS after IV rt-PA treatment and patients with increasing total CSVD score were more likely to have poor prognosis at 3 months.3.ROC analysis of 90-day functional outcomeIn ROC curve analysis,the total CSVD score value of 1.5 was the best cut-off value to differentiate between favourable prognosis and poor prognosis(AUC 0.7534[95%CI 0.6883-0.8185]).Besides,NIHSS score of 6.5 was the best one to identify the prognosis(AUC 0.7496[95%CI 06828-0.8165]).However,there was no obvious predictive value of OTT(AUC 0.5564[95%CI 0.4794-0.6334])in ROC analysis.Conclusions:1.The severity of total CSVD burden was closely related to HT of AIS after IV rt-PA treatment.Patients with severe CSVD have a high rate of HT.Severe CSVD was an independent risk factor of HT after thrombolysis.2.The total CSVD score was independently associated with the 3-month prognosis of AIS after IV rt-PA treatment.Patients with increasing total CSVD score were more likely to have poor prognosis at 3 months.The total CVSD score may be a reliable predictor for poor prognosis with a suggested value of CSVD score>2.