INTRODUCTION: Cerebral small vessel disease (CSVD) is prevalent in acute ischemic stroke (AIS) and may influence outcomes following intravenous thrombolysis with recombinant tissue plasminogen activator (r-tPA). This study examined associations between CSVD neuroimaging markers and early treatment response, defined as ≥4-point improvement on the National Institutes of Health Stroke Scale (NIHSS) at 24-48 hours. METHODS: In this retrospective cohort study at a tertiary stroke center (August 2020-November 2021), 154 AIS patients receiving r-tPA within 4.5 hours of onset underwent MRI within 48 hours after thrombolysis.CSVD markers (cerebral microbleeds CMBs, lacunar infarcts, white matter hyperintensities WMHs, enlarged perivascular spaces EPVSs) were assessed per STRIVE-2 standards, with total CSVD burden scored 0-4. Univariate and multivariable logistic regression analyzed associations with treatment response, adjusting for baseline NIHSS, sex, dyslipidemia, and visible infarction. RESULTS: = 0.036). CONCLUSIONS: Among CSVD markers, only CMBs were associated with poorer early r-tPA response in AIS. Given the retrospective design, small number of CMB-positive patients, and use of post-treatment MRI, these findings should be considered hypothesis-generating. Future prospective studies with pre-treatment and serial imaging are warranted.
Shayganfar et al. (Tue,) studied this question.
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