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The global burden of cerebral small vessel disease related to neurological deficit severity and clinical outcomes of acute ischemic stroke after IV rt-PA treatment

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Abstract

Background and purpose

Various types of cerebral small vessel diseases (CSVD) are commonly coexisting and the clinical outcome possibly is determined by their combined effect. The present study was designed to explore the possible relationship between the global burden of CSVD and clinical outcomes after recombinant tissue plasminogen activator (rt-PA) treatment of ischemic stroke.

Methods

We enrolled patients with acute ischemic stroke (AIS) after IV rt-PA treatment between August 2016 and July 2018. According to the total burden rating scale of CSVD, we calculated the total CSVD score for white matter hyperintensities, lacunar infarction, cerebral microbleeds, and perivascular spaces. All patients were assessed on the basis of the National Institutes of Health Stroke Scale (NIHSS) score and the modified Rankin Scale (mRS) score at 90 days after stroke. We used multivariate logistic regression analysis to examine the associations between global burden of CSVD and degree of neurological deficit and clinical outcomes. ROC curve analysis was used to determine cut-off values of the total CSVD score in predicting poor outcomes.

Results

The results showed that the total CSVD score was independently associated with moderate to severe stroke (OR 2.187, 95%CI 1.495–3.119, P < 0.001). Initial NIHSS (OR 1.23, 95%CI 1.144–1.330, P < 0.001), OTT (OR 1.007, 95%CI 1.000–1.014, P = 0.037), and CSVD score (OR 3.157, 95%CI 2.120–4.703, P < 0.001) was significantly related to poor functional outcome at 3 months. The total CVSD score cut-off value of 1.5 was determined at best to distinguish between good prognosis and poor outcome (AUC 0.7534 [95%CI 0.6883–0.8185]).

Conclusions

The global burden of CSVD was independently associated with neurological deficit severity and clinical outcomes of AIS after IV rt-PA treatment. The total CVSD score is a reliable predictor for poor outcomes of AIS after IV rt-PA treatment.

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Funding

This study was funded by the National Key R&D Program of China (2017YFC0114300) and Science and Technology Department Key Diseases Standardized Diagnosis and Treatment Project of Jiangsu Provincial.

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Author notes

  1. Xueyun Liu and Tan Li contributed equally to this work.

Authors and Affiliations

  1. Department of Neurology, The First Affiliated Hospital of Soochow University, No. 899, Pinghai Road, Suzhou, Jiangsu, 215006, People’s Republic of China

    Xueyun Liu, Tan Li, Shanshan Diao, Xiuying Cai, Yan Kong, Lulu Zhang, Zhuo Wang, Runnan Li, Yun Zhou & Qi Fang

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  1. Xueyun Liu
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Correspondence to Yun Zhou or Qi Fang.

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The study was approved by the ethics committees of the First Hospital Affiliated to Soochow University (No. 2018104) without need for informed consent.

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Liu, X., Li, T., Diao, S. et al. The global burden of cerebral small vessel disease related to neurological deficit severity and clinical outcomes of acute ischemic stroke after IV rt-PA treatment. Neurol Sci 40, 1157–1166 (2019). https://doi.org/10.1007/s10072-019-03790-x

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