Correlation Between The Severity Of Small Cerebral Vascular Disease And The Prognosis Of Acute Large Vascular Occlusive Stroke

Objective: The aim of this study is to investigate the relationship between the severity of Cerebral small vessel disease(CSVD)and the prognosis after endovascular treatment(EVT).Methods: Data were collected from 96 patients with acute ischemic major vascular occlusion stroke after EVT remdesivir at Ganzhou People’s Hospital from July 2021 to June 2022.MRI scans were completed within 72 hours of EVT treatment and the severity of the patient’s CSVD was assessed using the total CSVD score.Patients were followed up at 90 d and classified into good prognosis groups(m RS score 0-2)and poor prognosis groups(m RS score 3-6)based on Modified Rankin scale(m RS score).The association between overall load and 90 d prognosis in CSVD patients was further analyzed by multivariate logistic regression based on statistical differences in demographics,clinical data,and overall load severity of CSVD between the two groups.ROC curves were used to further analyze and predict the total CSVD score threshold for EVT patients with 90 d with poor prognosis.Results:1.Analysis of baseline dataNinety-six EVT patients were enrolled,with an average age of 64.08±10.66 years.The total CSVD score was 0 in 16 patients(16.1%),1 in 33 patients(34.4%),2 in 28 patients(29.2%),and 3 in 16 patients(19.8%).Hypertension(P = 0.019),atrial fibrillation(P = 0.020),smoking proportion(P = 0.005)and homocysteine(P= 0.019)increased with the increase of CSVD score;2.Single and multivariable logistic regression analysis of 90 d poor prognosis in EVT patientsPatients were followed up after 90 d,of whom 55(57.3%)had a good prognosis,while 41(42.7%)had a poor prognosis.In the single-variable analysis,older age(P= 0.006),higher baseline NIHSS score(P = 0.011),s ICH(symptomatic intracranial hemorrhage,s ICH)(P = 0.006),each CVD subtype(P < 0.05)and the total CSVD score(P < 0.001)were associated with poor prognosis after EVT.Further multivariable logistic regression analysis suggested that baseline NIHSS scores(OR= 1.173,95% CI: 1.036-1.329,P = 0.012),s ICH(OR = 12.046,95% CI:2.309-62.841,P = 0.003)and overall CVD burden were independently associated with post-EVT functional prognosis.3.ROC analysis of neurologic prognosisIn the ROC analysis,the total CSVD score cutoff of 1.5 was better able to distinguish between good and poor prognosis(AUC = 0.751,95% CI: 0.650.0.851,P< 0.001),presenting a sensitivity of 75.6% and a specificity of 70.9%;Furthermore,the prognosis was best assessed when the baseline NIHSS score cutoff was 7.5(AUC= 0.652,95% CI: 0.541-0.763,P = 0.011),with a sensitivity and specificity of 85.4%and 43.6%,respectively;Combined with the total CSVD score and baseline NIHSS to predict the risk of adverse prognosis after EVT,the area under ROC curve was0.791(AUC=0.791,95%CI: 0.6999-0.884,P < 0.001),with 73.2% sensitivity and80% specificity,indicating moderate predictive value.The total CSVD score combined with baseline NIHSS score can improve the predictive value of adverse prognosis after EVT.Conclusions: 1.In patients with AIS with large vessel occlusion treated with EVT,the CSVD total score is independently associated with outcomes at 90 days,and patients with a high total CSVD score are at increased risk of poor outcome.2.The total CSVD score > 2 can be used as an imaging predictor of poor short-term neurological outcome after EVT.The total CSVD score combined with baseline NIHSS score can improve the predictive value of adverse prognosis after EVT.