Small vessel disease burden may not portend unfavorable outcome after thrombectomy for acute large vessel occlusion

Zheng, Lemin; Leng, Xinyi; Nie, Ximing; H, Yan; Tian, Xuan; Pan, Yuesong; Yang, Zhi‐gang; Wen, Ming‐Shien; Pu, Yuehua; Gu, Weibin; Miao, Zhongrong; Leung, Thomas Wai Hong; Liu, Liping

doi:10.1007/s00330-022-08795-3

Cited by 9 publications

(5 citation statements)

References 27 publications

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“…In addition, our study showed that a high CSVD burden not only increased the risk of rapid IGR, but also correlated with higher rates of stroke progression and poor functional outcomes at 3 months. The association between CSVD burden and stroke outcomes remains controversial [4,6,31]. Our findings highlight the need for a more comprehensive assessment of CSVD in stroke patients, as it could serve as a potential prognostic factor and guide treatment decisions.…”

Section: Discussionmentioning

confidence: 86%

Effect of Cerebral Small Vessel Disease Burden on Infarct Growth Rate and Stroke Outcomes in Large Vessel Occlusion Stroke Receiving Endovascular Treatment

Sohn,

Kim,

Kim

et al. 2023

Biomedicines

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This study aimed to investigate the association between cerebral small vessel disease (CSVD) burden and infarct growth rate (IGR) in patients with large vessel occlusion (LVO) stroke who underwent endovascular treatment (EVT). A retrospective analysis was conducted on a cohort of 495 patients with anterior circulation stroke who received EVT. CSVD burden was assessed using a CSVD score based on neuroimaging features. IGR was calculated from diffusion-weighted imaging (DWI) lesion volumes divided by the time from stroke onset to imaging. Clinical outcomes included stroke progression and functional outcomes at 3 months. Multivariate analyses were performed to assess the relationship between CSVD burden, IGR, and clinical outcomes. The fast IGR group had a higher proportion of high CSVD scores than the slow IGR group (24.4% vs. 0.8%, p < 0.001). High CSVD burden was significantly associated with a faster IGR (odds ratio [95% confidence interval], 26.26 [6.26–110.14], p < 0.001) after adjusting for confounding factors. High CSVD burden also independently predicted stroke progression and poor functional outcomes. This study highlights a significant relationship between CSVD burden and IGR in LVO stroke patients undergoing EVT. High CSVD burden was associated with faster infarct growth and worse clinical outcomes.

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Section: Discussionmentioning

confidence: 86%

Effect of Cerebral Small Vessel Disease Burden on Infarct Growth Rate and Stroke Outcomes in Large Vessel Occlusion Stroke Receiving Endovascular Treatment

Sohn,

Kim,

Kim

et al. 2023

Biomedicines

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“…Here, preoperative collateral status was demonstrated as independent of the total CSVD score. There was only one study 6 investigating the role of the overall CSVD burden in MT outcome. Inconsistent with our study, that study reported that moderate-to-severe overall CSVD burden exhibited no distinct effect on the poor prognosis of ACLVOS patients receiving MT.…”

Section: Discussionmentioning

confidence: 99%

“…4 Nevertheless, various CSVD features usually coexist and influence each other. In this context, combination of more than one imaging features of CSVD has been increasingly used in clinical practice, [5][6] and it is more significant to explore the association between the overall CSVD burden (measured by total CSVD score) and the therapeutic outcome of thrombectomy. 7 To this end, the current retrospective case-control study aimed at probing into the association between the overall CSVD burden and 90-day outcome of MT in 145 patients with acute ACLVOS.…”

Section: Introductionmentioning

confidence: 99%

Overall cerebral small vessel disease burden is associated with outcome of acute ischemic stroke after mechanical thrombectomy

et al. 2022

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Objectives To investigate the association between the overall cerebral small vessel disease (CSVD) burden and the therapeutic outcome of mechanical thrombectomy (MT) in patients with acute anterior circulation large-vessel occlusion stroke. Materials and Methods Data of patients who achieved successful revascularization after MT for acute anterior circulation large-vessel occlusion stroke in the Ningbo Medical Center Lihuili Hospital between April 2017 and January 2022 were retrospectively analyzed. The overall CSVD burden was evaluated by total CSVD score based on MRI images. According to the 90-day modified Rankin Scale (mRS) score, the participants were divided into the Good outcome group (mRS score 0–2) and Poor outcome group (mRS score 3–6). Multivariate Logistic regression was applied to assess the relationship between the overal CSVD burdern and 90-day outcome. Results In total, 145 eligible patients were included and classified into the Good outcome group (n = 77, 62.3% males, mean age: 64.92 ± 13.67 years) and Poor outcome group (n = 68, 50% males, mean age: 69.76 ± 10.88 years). Symptomatic intracranial hemorrhage (OR = 2.788, 95%CI: 1.143–8.745, P = 0.048), poor preoperative collateral status (OR = 3.619, 95%CI: 1.670–7.844, P = 0.001), and high total CSVD score (score 2: OR = 3.800, 95%CI: 1.173 = 12.311, P = 0.026; score 3: OR = 7.529, 95%CI: 1.555–36.460, P = 0.012) were independently prognostic for poor 90-day outcome in patients receiving MT. Conclusion This study identified that the overall CSVD burden was independently associated with the prognosis of patients receiving MT for acute anterior circulation large-vessel occlusion stroke.

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“…It highlighted the potential implication of EPVS during the ischaemic process. Previous studies focused on the role of EPVS on clinical outcomes were limited to specific populations (such as patients with haemorrhage stroke), incomplete outcome assessment, relatively small sample size and short follow-up period 5 10 11. Furthermore, the relationships of EPVS with post-AIS/TIA outcomes remain poorly defined in patients with baseline CSVD burden or small arterial occlusion (SAO).…”

Section: Introductionmentioning

confidence: 99%

In patients who had a stroke or TIA, enlarged perivascular spaces in basal ganglia may cause future haemorrhagic strokes

et al. 2023

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IntroductionIt remains unclear whether enlarged perivascular spaces (EPVS) predict poor clinical outcomes in patients with acute ischaemic stroke (AIS) or transient ischaemic attack (TIA).MethodData were obtained from the Third China National Stroke Registry study. We estimated EPVS in basal ganglia (BG) and centrum semiovale (CSO) using a semiquantified scale (Grade from 0 to 4). Using Cox and logistic regression analyses, the associations of EPVS with 3-month and 1-year adverse outcomes (including recurrent stroke, ischaemic stroke, haemorrhagic stroke, combined vascular event, disability and mortality) were explored. Sensitivity analyses of any association of cerebral small vessel disease at baseline and development of a small arterial occlusion (SAO) were conducted.ResultAmong 12 603 patients with AIS/TIA, median age was 61.7±11.6 years, and 68.2% were men. After adjusting for all potential confounders, frequent-to-severe BG-EPVS was associated with a decreased risk of recurrent ischaemic stroke (HR 0.71, 95% CI 0.55 to 0.92, p=0.01) but an increased risk of haemorrhagic stroke (HR 1.99, 95% CI 1.11 to 3.58, p=0.02) at 1 year after AIS/TIA, compared with none-to-mild BG-EPVS. Patients with frequent-to-severe CSO-EPVS had a decreased risk of disability (OR 0.76, 95% CI 0.62 to 0.92, p=0.004) and all-cause death (HR 0.55, 95% CI 0.31 to 0.98, p=0.04) within 3-month but not 1-year follow-ups, compared with those with none-to-mild BG-EPVS. Sensitivity analyses showed that both BG-EPVS (HR 0.43, 95% CI 0.21 to 0.87, p=0.02) and CSO-EPVS (HR 0.58, 95% CI 0.35 to 0.95, p=0.03) were associated with a decreased risk of subsequent ischaemic stroke in patients with SAO during 1-year follow-up.ConclusionBG-EPVS increased the risk of haemorrhagic stroke in patients already with AIS/TIA within 1 year. Therefore, caution is recommended when selecting antithrombotic agents for secondary stroke prevention in patients with AIS/TIA and more severe BG-EPVS.

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Small vessel disease burden may not portend unfavorable outcome after thrombectomy for acute large vessel occlusion

Cited by 9 publications

References 27 publications

Effect of Cerebral Small Vessel Disease Burden on Infarct Growth Rate and Stroke Outcomes in Large Vessel Occlusion Stroke Receiving Endovascular Treatment

Effect of Cerebral Small Vessel Disease Burden on Infarct Growth Rate and Stroke Outcomes in Large Vessel Occlusion Stroke Receiving Endovascular Treatment

Overall cerebral small vessel disease burden is associated with outcome of acute ischemic stroke after mechanical thrombectomy

In patients who had a stroke or TIA, enlarged perivascular spaces in basal ganglia may cause future haemorrhagic strokes

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