Impact of Small Vessel Disease on Patient Outcomes After Intravenous Thrombolysis for Acute Ischemic Stroke

Individual cerebral small vessel disease (SVD) markers independently predict poor prognosis after stroke. However, the impact of a single SVD, especially cumulative SVD burden, on outcomes in acute ischemic stroke (AIS) after intravenous thrombolysis remains unclear. This study evaluated the occurrence of SVD in patients with AIS who were treated with intravenous thrombolytic therapy using multimodal magnetic resonance imaging. The study involved patients with AIS who received multimodal magnetic resonance imaging scans before receiving intravenous thrombolytic treatment with recombinant tissue plasminogen activator (rt-PA). Validated scales were used to document each SVD characteristic and measure the overall impact of SVD using an extensive scoring method. Functional outcomes were evaluated using the modified Rankin scale score within a 3-month time frame, with poor outcomes categorized as a modified Rankin scale score of ≥2. Using a logistic regression model while accounting for potential confounding variables, we examined the relation among individual SVD characteristics, the overall SVD impact, and patient outcomes. In total, 282 patients were included. Severe white matter hyperintensities and lacunas were linked to negative clinical results in patients with SVD, even after accounting for age, National Institutes of Health Stroke Scale score at admission, onset to treatment time, and hypertension (odds ratio 2.394, 95% confidence interval 1.246 to 4.6; odds ratio 2.3, 95% confidence interval 1.214 to 4.36, respectively). When evaluating the SVD global burden, a strong association between the SVD score and negative clinical results was observed, except for cases with an SVD score of 2 points. The findings suggest that the presence of pre-existing SVD, particularly characterized by the severity of white matter changes and lacunes, has a detrimental impact on the clinical outcomes of patients with ischemic stroke receiving intravenous rt-PA treatment. In conclusion, this information could be useful for predicting the prognosis of patients with stroke who underwent intravenous rt-PA therapy.