Neuroimaging Markers of Cerebral Small Vessel Disease on Hemorrhagic Transformation and Functional Outcome After Intravenous Thrombolysis in Patients With Acute Ischemic Stroke: A Systematic Review and Meta-Analysis.

Liming Lu,Shuqi Ge,Nenggui Xu,Lin Wang,Yiqiao Wang,Xiaoting Yan,Guangming Zhang,Jie Zhan,Hao Wen,Peiming Zhang

doi:10.3389/fnagi.2021.692942

Abstract

Objective: The aim of this study was to perform a systematic review and meta-analysis to assess whether cerebral small vessel disease (CSVD) on neuroimaging of patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT) is associated with an increased risk of hemorrhagic transformation (HT), symptomatic intracranial hemorrhage (sICH), and poor functional outcome (PFO).Methods: A thorough search of several databases was carried out to identify relevant studies up to December 2020. We included studies of patients with AIS and neuroimaging markers of CSVD treated with IVT. The primary outcome was HT, and the secondary outcomes were sICH and 3-month PFO. The quality of the studies involved was evaluated using the Newcastle–Ottawa Scale (NOS). The meta-analysis with the fixed effects model was performed.Results: Twenty-four eligible studies (n = 9,419) were pooled in the meta-analysis. All included studies were regarded as high quality with the NOS scores of at least 6 points. The meta-analysis revealed associations between the presence of CSVD and HT, sICH, and the 3-month PFO after IVT. Compared with no CSVD, the presence of CSVD was associated with an increased risk of HT (OR: 1.81, 95% CI: 1.52–2.16), sICH (OR: 2.42, 95% CI: 1.76–3.33), and 3-month PFO (OR: 2.15, 95% CI: 1.89–2.44). For patients with AIS complicated with CSVD, compared with a CSVD score of 0–1, a CSVD score of 2–4 was associated with an increased risk of HT (OR: 3.10, 95% CI: 1.67–5.77), sICH (OR: 2.86, 95% CI: 1.26–6.49), and 3-month PFO (OR: 4.58, 95% CI: 2.97–7.06).Conclusion: Patients with AIS complicated with neuroimaging markers of CSVD are at increased risk of HT and 3-month PFO after IVT. However, it is still necessary to clarify the exact role of CSVD in the occurrence, development, and prognosis of AIS.Systematic Review Registration: www.ClinicalTrials.gov, identifier CRD4202123 3900.

Highlights

Stroke is the second leading cause of death worldwide, leading to death in 5.5 million people and affecting 13.7 million each year
The neuroimaging markers of Cerebral small vessel disease (CSVD) included cerebral cerebral microbleed (CMB), white matter hyperintensity (WMH), and lacunar infarction (LI), and no studies related to enlarged perivascular space (EPVS) were found
Compared with no CSVD, the presence of CSVD was associated with an increased risk of Hemorrhagic transformation (HT) (OR: 1.81, 95% CI: 1.52–2.16) (Figure 2)

Summary

Introduction

Stroke is the second leading cause of death worldwide, leading to death in 5.5 million people and affecting 13.7 million each year. Ischemic stroke accounts for 70% of all patients with stroke. Cerebral small vessel disease (CSVD) is a widespread cerebrovascular disease with specific neuroimaging characteristics (Chen et al, 2019). With the development of neuroimaging technology, the brain imaging of more patients with acute ischemic stroke (AIS) has detected the neuroimaging markers of CSVD such as cerebral microbleed (CMB), white matter hyperintensity (WMH), lacunar infarction (LI), and enlarged perivascular space (EPVS) (Curtze et al, 2016; Chen et al, 2019). CSVD accounts for 25% of cases of AIS, and it affects cognitive function, gait disturbance, swallowing, and other functions (Pantoni, 2010)

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Conclusion