Effect Of Perivascular Space Enlargement On The Outcome Of Intravenous Thrombolytic Therapy In Patients With Acute Ischemic Stroke

Objective:To investigate the influence of the severity of enlarged perivascular space(EPVS)on the prognosis of neurological function in patients with acute ischemic stroke(AIS)3 months after intravenous thrombolysis with rt-PA.Methods:The general baseline data of AIS patients who received intravenous thrombolytic therapy with recombinant tissue plasminogen activator(rt-PA)from July 2019 to February 2021 in the Department of Neurology,Second Affiliated Hospital of Guangxi Medical University were collected.During hospitalization,the cranial MRI examination was completed,and the perivascular space enlargement was graded according to cranial MRI.The modified Rankin Scale(MRS)was followed up by telephone 90 days after the onset to evaluate the prognosis of the patients.The good prognosis was defined as Mrs score≤1.Multivariate logistic regression analysis was used to analyze the independent influencing factors of 90 day poor prognosis(MRS score≥ 2)and in-hospital complications(new pulmonary infection,urinary system infection,gastrointestinal bleeding and liver and kidney function damage).At the same time,multivariate logistic regression was used to analyze the independent risk factors of perivascular space enlargement in AIS patients with intravenous thrombolysis.Results:Finally,74 patients were enrolled,with an average age of 62.7±12.5 years old,the youngest age was 24 years old,and the oldest age was 91 years old.Among them,48 were male patients(64.9%).Patients with moderate to severe BG-EPVS(grade≥2)36 patients(48.6%),54 patients(73.0%)with moderate to severe CSO-EPVS(grade≥2),and 24 patients(32.4%)with poor prognosis after 90 days of intravenous thrombolysis.Multivariate analysis showed:1.NIHSS score before thrombolysis(OR 1.156,95%CI 1.007～1326,P=0.04<0.05),moderate to severe BG-EPVS(grade≥ 3)(OR 4.681,95%CI 1.067～20.542,P=0.041<0.05)is an independent risk factor for poor prognosis of intravenous thrombolysis in AIS patients;2.Severe BG-EPVS(OR 4.507,95%CI 1.054-19.273,P=0.042<0.05)is an independent risk factor for new complications during hospitalization after intravenous thrombolysis in AIS patients.Conclusion:1.Moderate to severe BG-EPVS AIS patients is 90 days after the intravenous thrombolytic independent risk factor for poor prognosis;2.Severe BG-EPVS is an independent risk factor emerging complication of AIS patients after intravenous thrombolytic therapy during hospitalization.