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Small vessel disease and clinical outcomes after endovascular treatment in acute ischemic stroke

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Abstract

Background

Pre-existing small vessel disease (SVD) has been associated with poor functional outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis; however, there are scarce data in patients treated with endovascular therapy. We aimed to investigate the associations between SVD and clinical outcomes in patients treated with endovascular therapy.

Methods

We retrospectivel y evaluated patients with acute ischemic stroke in the anterior circulation receiving endovascular treatment. We assessed SVD markers with visual scales using non-contrast computed tomography. Early outcomes included intracerebral hemorrhage and 7-day/discharge stroke severity, and late outcomes included modified Rankin scale (mRS) 90 days after stroke. We used logistic and ordinal regression models adjusted for age, sex, stroke severity, and time-to-groin puncture time.

Results

A total of 175 patients were included in the study, mean (±SD) age 72.3 (± 12.4) years, 90 (51%) males. Among SVD features, only brain atrophy was associated with 7-day stroke severity (OR = 2.28; 95% CI = 1.11–4.68) and with worse mRS at 90 days (OR = 2.72; 95% CI = 1.25–5.91). Global SVD burden was associated with worse mRS at 90 days (OR = 1.63; 95% CI = 1.01–2.62) but not with 7-day stroke severity (OR = 1.71; 95% CI = 0.97–3.01).

Conclusions

Pre-existing SVD burden, mainly driven by brain atrophy, negatively affects early and late clinical outcomes in anterior circulation ischemic stroke treated with endovascular therapy. Our results may help prognostic stratification of stroke patients treated with endovascular therapy.

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Authors and Affiliations

  1. Geriatric Department, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy

    Francesco Arba, Giuseppe Dario Testa & Patrizia Nencini

  2. NEUROFARBA Department, University of Florence, Florence, Italy

    Francesco Arba, Giuseppe Dario Testa, Giovanni Pracucci & Domenico Inzitari

  3. Neurovascular Interventional Unit, Careggi University Hospital, Florence, Italy

    Nicola Limbucci, Sergio Nappini & Leonardo Renieri

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  1. Francesco Arba
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Arba, F., Testa, G.D., Limbucci, N. et al. Small vessel disease and clinical outcomes after endovascular treatment in acute ischemic stroke. Neurol Sci 40, 1227–1235 (2019). https://doi.org/10.1007/s10072-019-03824-4

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  • DOI: https://doi.org/10.1007/s10072-019-03824-4

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