Analysis of the Impact of Cerebral Small Vessel Disease on Neurological Outcomes in Patients with Basal Ganglia/Corona Radiata Ischemic Stroke Treated with Intravenous Thrombolysis under Multimodal MRI Guidance

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Abstract
This study investigated the impact of pretreatment small vessel disease (SVD) burden on outcomes in acute ischemic stroke (AIS) patients with infarcts in SVD-vulnerable regions (basal ganglia or corona radiata) undergoing intravenous thrombolysis (IVT). We enrolled 346 patients from Tianjin Huanhu Hospital (August 2023–January 2025) within 4.5 hours of onset. Pretreatment MRI assessed SVD burden using a validated 0–4 scale based on white matter hyperintensities (WMH), lacunar infarcts, cerebral microbleeds (CMBs), and enlarged perivascular spaces. Patients were categorized as absent-to-mild (0–1) or moderate-to-severe (≥2) SVD. Primary outcomes were early neurological deterioration (END; NIHSS increase ≥4 within 24 hours) and poor functional outcome (mRS >2 at 90 days); secondary outcomes included symptomatic intracranial hemorrhage (sICH) and malignant cerebral edema within 24 hours. Multivariable logistic regression models were sequentially adjusted for individual SVD markers. Of the patients (mean age 62.88 ± 10.21 years; 70.8% male), 139 (40%) had moderate-to-severe SVD. This group had higher risks of END (9.4% vs. 2.9%; OR = 2.534, 95% CI: 1.540–4.170), mRS >2 (12.9% vs. 4.3%; OR = 1.928, 95% CI: 1.303–2.852), and sICH (6.4% vs. 2.1%; OR = 1.639, 95% CI: 1.015–2.647). Deep WMHs independently predicted END, poor outcome, and sICH in marker-specific models. CMBs showed the strongest association with sICH (OR = 6.080, 95% CI: 1.834–20.156), and remained significant after full adjustment (OR = 5.353, 95% CI: 1.400–20.471). Other markers lost significance when mutually adjusted. In conclusion, higher pretreatment SVD burden predicts adverse outcomes post-IVT in patients with basal ganglia or corona radiata infarcts. While deep WMHs and CMBs are key predictors, only CMBs independently predict sICH after full adjustment. Rapid, multimodal MRI-based SVD assessment may improve pre-therapeutic risk stratification and support individualized IVT decisions. Prospective validation is warranted.
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Authors Zhang, Peilan
Journal Frontiers in pharmacology
Year Year not found
DOI
10.3389/fneur.2025.1645980
URL
https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2025.1645980/full
Keywords Keywords not found

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