Correlation Between Enlarged Perivascular Spaces And Functional Outcome Of Thrombolytic Therapy In Acute Ischemic Stroke

Objective:To evaluate the severity of enlarged perivascular spaces(EPVS)in acute ischemic stroke patients receiving thrombolytic therapy with rt-PA,analyze the correlation between EPVS and outcomes such as neurological prognosis and hemorrhage transformation in thrombolytic patients,and explore whether EPVS can be used as a new imaging marker to predict the outcome of thrombolysis patients.Methods:A total of 351 patients with acute cerebral infarction who received rt-PA thrombolytic therapy in the Department of Neurology of North Jiangsu People’s Hospital from January 2020 to December 2022 were included.Demographic information and clinical baseline data of all patients were collected,and NIHSS score before thrombolytic therapy and the time from symptom onset to thrombolytic therapy were recorded.Head MRI examination was performed in all patients,and EPVS were counted at basal ganglia(BG)and center semicovale(CSO)respectively.mRS Scale was used to evaluate the 90-day prognosis of neurological function in thrombolysis patients,and the presence of hemorrhage transformation and symptomatic hemorrhage transformation were determined by head CT review and clinical symptoms during hospitalization.Patients were divided into no-mild and moderate-severe groups according to EPVS at different sites.Univariate analysis was performed to compare the differences in baseline data,90-day prognosis,and with/without hemorrhage transformation between the two groups.Multivariate analysis was performed to analyze the risk factors of BG-EPVS and CSO-EPVS.All patients were divided into good prognosis group and poor prognosis group according to 90-day mRS Score.Binary logistic regression was used to analyze the independent risk factors of 90-day poor prognosis in thrombolytic patients.ROC curve was used to evaluate the predictive value of EPVS for 90-day poor prognosis in thrombolytic patients,and Youden index was used to analyze the optimal tipping point between EPVS for 90-day poor and good prognosis in patients.All patients were divided into a no-hemorrhage transformation group,an asymptomatic hemorrhage transformation group,and a symptomatic hemorrhage transformation group.Baseline data and functional outcomes of the three groups were compared.Binary logistic regression was used to analyze the independent risk factors of hemorrhage transformation and symptomatic hemorrhage transformation in thrombolytic patients.ROC curve was used to evaluate the predictive value of EPVS for hemorrhage transformation in thrombolytic patients,and Youden index was used to analyze the optimal tipping point of EPVS with or without hemorrhage transformation in patients.Results:1.A total of 351 patients were included in this study,including 306 cases without-mild BG-EPVS and 45 cases with moderate-severe BG-EPVS.Compared with the group without-mild BG-EPVS,the moderate-severe BG-EPVS group had poor prognosis and increased incidence of hemorrhage transformation at 90 days,and the difference was statistically significant.(P<0.05)2.Binary logistic regression analysis showed that age,admission NIHSS score,CSO-EPVS and BG-EPVS were independently correlated;There was an independent correlation between cerebral infarction,BG-EPVS and CSO-EPVS(P<0.05).3.The baseline data of patients in the no-hemorrhage transformation group,asymptomatic hemorrhage transformation group and symptomatic hemorrhage transformation group were compared,and the overall difference of BG-EPVS among the three groups was statistically significant(P=0.001),and further pair-to-pair comparison showed statistically significant difference of BG-EPVS between the no-hemorrhage transformation group and the asymptomatic hemorrhage transformation group(P=0.001).There was no significant difference in BG-EPVS between the residual hemorrhage transformation group and the symptomatic hemorrhage transformation group,or between the asymptomatic hemorrhage transformation group and the symptomatic hemorrhage transformation group(P>0.167).There was no significant difference in CSO-EPVS among the three groups(P=0.449).4.After adjusting for confounding factors such as NIHSS score before thrombolysis and drinking history,binary logistic regression analysis showed that moderate-severe BG-EPVS were independent risk factors for 90-day prognosis in patients with thrombolysis,with an OR value of 2.078(95%CI 1.065-4.052,P=0.032).ROC curve analysis showed that the AUC between BG-EPVS and the prognosis of thrombolysis patients was 0.638(95%Cl:0.579-0.696,P=0.000),using Yoden index analysis showed that the optimal critical point of BG-EPVS in thrombolytic patients with poor prognosis and good prognosis was 0.5(sensitivity=0.646,specificity=0.595).There was no significant correlation between CSO-EPVS and 90-day prognosis in thrombolysis patients.5.After adjusting for confounder factors,binary logistic regression analysis showed that moderate-severe EPVS were independent risk factors for hemorrhage transformation in thrombolysis patients,with OR values of 2.957(95%CI 1.300-6.727,P=0.010).ROC curve analysis showed that the AUC between BG-EPVS and hemorrhage transformation in thrombolytic patients was 0.694(95%CI:0.612-0.776,P=0.000),using Yoden index analysis showed that the optimal critical point of BG-EPVS with/without hemorrhage transformation in thrombolytic patients was 0.5(sensitivity=0.745,specificity=0.563).There was no significant correlation between CSO-EPVS and hemorrhage transformation in thrombolysis patients.6.Binary logistic regression analysis showed no significant correlation between BG-EPVS and CSO-EPVs and symptomatic hemorrhage transformation in thrombolytic patients.Conclusions:1.Age,NIHSS score,CSO-EPVS and BG-EPVS were independently correlated.There was an independent correlation between cerebral infarction,BG-EPVS and CSO-EPVS.2.Moderate to severe BG-EPVS was an independent risk factor for 90-day poor prognosis in thrombolytic patients,and there was no significant correlation between CSO-EPVS and 90-day poor prognosis in thrombolytic patients.3.Moderate-severe BG-EPVS were independent risk factors for hemorrhage transformation in thrombolytic patients,and there was no significant correlation between CSO-EPVS and hemorrhage transformation in thrombolytic patients.No significant correlation was found between BG-EPVS and CSO-EPVS and symptomatic hemorrhage transformation.