Effect Of The Total Burden Of Cerebral Small Vessel Disease On The Prognosis Of Intravenous Thrombolysis In Acute Ischemic Stroke Patients

Objective:To study the effect of the total cerebral small vessel disease(CSVD)burden on the14-day neurological recovery and 90-day clinical prognosis of patients with acute ischemic stroke(AIS)after intravenous thrombolysis.Methods:A total of 99 patients with AIS who were treated with intravenous thrombolysis in the Department of Neurology of Taizhou People’s Hospital from September 2019 to October 2020 were collected,and cranial magnetic resonance examination was completed within 72 hours after thrombolysis.The total CSVD burden scoring principle:(1)lacuna was 1 point;(2)cerebral microbleeds was 1 point.(3)When the enlarged perivascular space in basal ganglia area was ≥ 10,it was 1 point;(4)When the periventricular white matter degeneration was irregular and extended to the deep white matter,with or without the deep brain white matter degeneration began to appear fusion,it was 1 point;The sum of the above 4 items is the total CSVD burden score.The NIHSS scores were recorded before thrombolysis and 14 days after thrombolysis.A decrease of ≥18% in NIHSS score after 14 days of thrombolysis compared with the pre-thrombolysis NIHSS score was considered as improvement in neurological function,while a decrease of < 18% or an exacerbation was considered as no improvement in neurological function.The m RS score at 90 days after thrombolysis was record.The m RS score of 0 ～ 2 and 3 ～ 6 was considered as good and poor prognosis,respectively.To analyze the trend of the proportion of people with improved neurological function at14 days under different total CSVD burden.The influence of total CSVD burden on short-term prognosis at 90 days was studied by multivariate analysis,and ROC curve analysis was used to discover the predictive significance and cut-off value of total CSVD burden on 90-day prognosis.Results:1.Comparison of data between patients in CSVD 0 ～ 1 group and CSVD 2 ～ 4 groupThere are 99 patients in this study,and their average age was 67.09 ± 12.54 years,including 68 males(68.7%).The total CSVD burden ranging from 0 to 4 were 12 cases(12.1%),31 cases(31.3%),24 cases(24.3%),23 cases(23.2%),and 9 cases(9.1%).The total CSVD burden was further grouped,including 43 cases in CSVD 0 ～ 1 group and56 cases in CSVD 2 ～ 4 group.Age(P=0.001)and hypertension(P=0.028)had statistically significant differences.2.Relationship between the total CSVD burden and neurological function improvement at 14 daysThe total CSVD burden was divided into 5 groups based on score.The percentage of patients with improved 14-day NIHSS scores in each group from 0 to 4 was 83.33%,90.32%,62.5%,65.22% and 44.44%.According to the results of the linear-by-linear association chi-square test,there was a negative linear relationship between the total CSVD burden and the proportion of patients with improved 14-day NIHSS score(x~2=8.057,P=0.005).3.Univariate and multivariate analysis of clinical outcomes at 90 daysThe prognosis at 90 days was divided into groups according to different outcomes.69 cases had good prognosis and 30 cases had poor prognosis.In univariate analysis,there were statistically significant differences in pre-thrombolytic NIHSS score,the total CSVD burden,WMH,lacuna and cerebral infarction(P < 0.05).In multivariate Logistic regression analysis,pre-thrombolytic NIHSS score(OR=0.789,95%CI:0.688～0.905,P=0.001)and the total CSVD burden(OR=0.307,95%CI:0.095～0.987,P=0.047)were independent risk factors for intravenous thrombolysis in AIS patients.4.ROC curve analysis of 90-day clinical outcomesThe cut-off value of the total CSVD burden was 2.5 points(AUC=0.746,95%CI :0.636 ～ 0.857,P < 0.001),sensitivity was 63%,specificity was 81%.The cut-off value of pre-thrombolytic NIHSS score was 8.5 points(AUC=0.764,95%CI :0.665 ～ 0.863,P < 0.001),sensitivity was 63%,specificity was 81%.The total CSVD burden and pre-thrombolytic NIHSS score can be used as predictors of clinical outcome at 90 days.Conclusion:1.As the total CSVD burden score increases,there was a decreasing trend in the proportion of patients with improved neurological function at 14 days after thrombolysis.2.The total CSVD burden and pre-thrombolytic NIHSS score were independent risk factors for the 90-day clinical prognosis in patients with AIS treated after intravenous thrombolysis with rt-PA.When the total CSVD burden was ≥ 3 points,it could be used as a predictor of the 90-day clinical prognosis.