Correlation Between Enlarged Perivascular Space And Early Neurological Deterioration After Intravenous Thrombolysis In Acute Ischemic Stroke

Objective:To analyze risk factors for early neurological deterioration in acute ischemic stroke(AIS)patients undergoing intravenous thrombolysis with alteplase.To investigate the association between enlarged perivascular space(EPVS)and early neurological deterioration after intravenous thrombolysis by alteplase.Methods:A total of 149 patients with AIS admitted to the Stroke Center of the Second Affiliated Hospital of Anhui Medical University from April 2020 to January 2022 were retrospectively collected,and all patients received intravenous thrombolytic therapy with a standard dose of recombinant tissue plasminogen activator(rt-PA)within 4.5 hours of onset.General data,laboratory indicators and imaging data were collected to explore possible risk factors for EPVS in the basal ganglia region and the hemioval center,respectively.According to whether the included patients had early neurological deterioration(END)during hospitalization,all patients were divided into END group and non-END group,and univariate data analysis was performed on the data between the END group and the non-END group,and the risk factors that may be related to END were screened out,and then introduced into the binary logistic regression analysis model for further analysis.To investigate the association between EPVS and the occurrence of END after intravenous thrombolysis.Results:(1)The severity of EPVS in the basal ganglia area and the center of the hemioval was compared respectively,and the results showed that the severity of EPVS in the basal ganglia area was closely related to the history of hypertension,paraventricular white matter hyperintensity(PVWMH)and deep white matter hyperintensity(DWMH).,the difference was statistically significant(P<0.05),while the severity of EPVS in the center of the hemioval center was only associated with a history of hypertension(P<0.05).(2)Univariate analysis results of END group and non-END group showed that there were significant differences in NIHSS score before thrombolysis,NIHSS score immediately after thrombolysis,systolic blood pressure at admission,blood glucose at admission,hemorrhagic transformation after thrombolysis,moderate to severe PVWMH,moderate to severe DWMH,moderate and severe basal ganglia EPVS,and moderate to severe hemioval center EPVS(P <0.05)。 Further multivariate logistic regression analysis showed that blood glucose(OR=1.254,95%CI:1.027～1.531,P=0.026),hemorrhagic transformation after thrombolysis(OR=4.930,95%CI: 1.084～22.413,P=0.039),moderate to severe DWMH(OR=4.197,95%CI:1.270～13.874,P=0.019),Moderate to severe basal ganglia EPVS(OR=5.487,95%CI:1.849～16.287,P=0.002)was an independent risk factor for END after thrombolysis.Conclusion:(1)The history of hypertension,moderate to severe PVWMH,and moderate to severe DWMH were associated with the severity of EPVS in the basal ganglia,while the severity of EPVS in the center of the hemioval center was only related to the history of hypertension.(2)Blood glucose at admission,hemorrhagic transformation after thrombolysis,moderate to severe DWMH and moderate to severe basal ganglia EPVS were independent risk factors for END after rt-PA venous thrombolysis.