| Objective To investigate the effect of cerebral small vessel disease(CSVD)on hemorrhage transformation(HT)and short-term prognosis(90 days)after endovascular therapy(EVT)for acute ischemic stroke-large vessel occlusive(AIS-LVO).Methods The present study was a retrospective study of patients who were clinically diagnosed with AIS-LVO and EVT in the Department of Neurology of Baotou Central Hospital from January 2018 to December 2020.All the enrolled patients underwent craniocerebral multi-mode mri examination during perioperative period.The CSVD total load Scale was used to evaluate the overall CSVD load of the patients.The WMH load was evaluated by Fazekas scale,and the paravicular WMH was 3 points or the deep WMH was 2 or 3 points,and 1 point was scored,which was defined as moderate to severe WMH in this study.The number of cerebral microbleeds(CMB)≥1,1 point;The perivascular space(PVS)in the basal ganglia region was graded from 2 to 4,and 1 point was scored.If the number of cavities(LI)is ≥1,score 1.The total CSVD load score of the enrolled patients was calculated,and the total CSVD load was divided into three grades: mild(0-1 points),moderate(2points)and severe(3-4 points).All the enrolled patients underwent head non-enhanced computed tomography(NCCT)immediately and 24 hours after surgery to determine postoperative HT according to Heidelberg criteria.MRS scale score was taken as the standard,and the prognosis of patients was followed up by telephone 90 days after surgery.In this study,m RS score ≤2 was defined as a good short-term prognosis.The baseline,clinical,imaging and follow-up information of the patients were recorded in detail,and the data were collated for statistical analysis :(1)the patients were divided into two groups according to whether HT occurred after EVT.The differences in baseline data between the groups were compared,and the relationship between the overall CSVD load,moderate and severe WMH,CMB and HT after EVT was further explored by logistic regression method.(2)The patients were divided into two groups according to whether the short-term prognosis was good or not.The baseline data between the groups were compared,and the relationship between the total CSVD load,moderate to severe WMH and CMB and the short-term prognosis of EVT was further explored by logistic regression method.ROC curve was used to further analyze the critical value of CSVD overall load score which predicted poor short-term prognosis of EVT.Results(1)Analysis of baseline data: A total of 101 patients were enrolled in this study,with an average age of 61.53±11.94 years,including 71 male patients(70%).According to CSVD overall load score,the patients were divided into three groups:mild group 41 cases(40.6%),male 33 cases(80.5%);There were 28 patients(27.7%)in the moderate group and 19 patients(67.9%)in the male group.There were 32patients(31.7%)in the severe group,and 19 patients(59.4%)in the male group.Patients in the severe CSVD overall load group were the oldest,with the highest admission systolic blood pressure(SBP)and NIHSS scores,and the combined rates of coronary heart disease,atrial fibrillation,moderate and severe WMH and CMB were the highest,followed by the moderate group,and the mild group were the lowest,with statistical significance(P<0.05).In this study,there were 29 cases(28.7%)with moderate to severe WMH,89 cases(88.1%)with LI≥1,34 cases(33.7%)with CMB≥1,and 36 cases(35.6%)with GRADE 2-4 PVS in the basal ganglia region.The load distribution of patients with CMB: 1 CMB in 8 cases(23.5%),2-4 CMB in 14cases(41.2%),≥5 CMB in 12 cases(35.3%).(2)The relationship between overall CSVD load,moderate and severe WMH,CMB and HT after EVT: In this study,45patients(44.6%)and 30 male patients(66.7%)developed HT;There were 7 s ICH patients(6.9%)and 3 male patients(42.9%).Univariate analysis of the HT group and the HT group showed that the NIHSS score,the number of anterior circulation system lesions,the combined rate of atrial fibrillation and CMB in the HT group were higher than those in the HT group,while ASPECTS score and the proportion of tirofibans in the operation were lower than those in the HT group,with statistically significant differences(P<0.05).Multivariate logistic regression analysis showed that CMB was a risk factor for HT after EVT(OR=3.84,95%CI: 1.29-11.46).In addition,patients with severe CSVD overall load had a higher incidence of s ICH after EVT than patients with mild CSVD overall load,the difference being statistically significant(P=0.014).(3)The relationship between overall CSVD load,moderate to severe WMH,CMB and short-term prognosis of EVT: In this study,48 patients(47.5%)and30 male patients(62.5%)had poor short-term prognosis.Univariate analysis between the good prognosis group and the poor prognosis group showed that the NIHSS score and the combined rates of coronary heart disease,atrial fibrillation and CSVD in the poor prognosis group were higher than those in the good prognosis group,and the differences were statistically significant(P<0.05).Multivariate logistic regression analysis showed that moderate and severe WMH(OR=3.20,95%CI: 1.10-9.26)and CMB(OR=3.03,95%CI: 1.14-8.06)were risk factors for poor short-term prognosis of EVT.With mild CSVD overall load as reference,moderate(OR=5.68,95%CI:1.53-21.07)and severe(OR=50.78,95%CI: 8.61-299.65)CSVD overall load was a risk factor for poor short-term prognosis of EVT.ROC curve analysis of short-term prognosis: CSVD with a cutoff point of 1.5 overall load score could better distinguish good short-term prognosis from poor prognosis(AUC 0.786,95%CI: 0.695～0.876),with 83.3% sensitivity and 62.3% specificity.Conclusion(1)CMB is a risk factor for HT and poor short-term prognosis after EVT,and moderate to severe WMH is a risk factor for poor short-term prognosis of EVT.(2)The overall load of mild CSVD was used as reference,and the overall load of moderate and severe CSVD was a risk factor for poor short-term prognosis of EVT;CSVD overall load score ≥2 can be used as a radiographic predictor of poor short-term prognosis of EVT in AIS-LVO patients. |
