The global burden of cerebral small vessel disease related to neurological deficit severity and clinical outcomes of acute ischemic stroke after IV rt-PA treatment

Liu, Xueyun; Li, Tan; Diao, Shanshan; Cai, Xiuying; Kong, Yan; Zhang, Lulu; Wang, Zhuo; Li, Runnan; Zhou, Yun; Fang, Qi

doi:10.1007/s10072-019-03790-x

Cited by 30 publications

(34 citation statements)

References 32 publications

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“…Both percentages were lower than our observations. However, another study found that 85% of patients with moderate to severe stroke had one or more markers of SVD (29), which was similar to our percentage. Differences in the populations included in the studies may explain the discrepancies between the results.…”

Section: Discussionsupporting

confidence: 89%

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A Non-linear Association Between Total Small Vessel Disease Score and Hemorrhagic Transformation After Ischemic Stroke With Atrial Fibrillation and/or Rheumatic Heart Disease

Wei

Liu

et al. 2019

Front. Neurol.

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Background: Previous studies have investigated the association between a single marker of cerebral small vessel disease (SVD) and hemorrhagic transformation (HT). However, the effect of the total SVD burden on HT has not been evaluated yet. We aimed to investigate the association between the total SVD score and HT in ischemic stroke patients with atrial fibrillation (AF) and/or rheumatic heart disease (RHD). Methods: Ischemic stroke patients with AF and/or RHD admitted within 7 days after onset were enrolled at two hospitals in China. The total SVD score was based on the presence of lacunes, extensive white matter hyperintensities, cerebral microbleeds, and moderate to severe enlarged perivascular spaces in the basal ganglia. One point was awarded for the presence of each marker, with the total SVD score ranging from 0 to 4 points. HT was assessed based on follow-up imaging scans during hospitalization and was classified according to the radiographic appearance and associated neurological deterioration. Results: Of 207 enrolled patients (mean age, 67.79 years; 58.9% female), 89 (43.0%) developed HT. The distribution of the total SVD score was significantly different between patients with and without HT in the univariate analysis ( p = 0.04). After adjustment for confounders, a SVD score of 1 was independently associated with an increased risk of HT [odds ratio (OR), 3.23; 95% confidence interval (CI), 1.48–7.04; p = 0.003], while a SVD score ≥2 was inversely related to the occurrence of HT (OR, 0.41; 95% CI, 0.19–0.91; p = 0.03). These independent associations remained significant in the subgroups of hemorrhagic infarction and asymptomatic HT (all p < 0.05). Conclusions: In our study, the relationship between the total SVD score and HT was not linear, since the presence of only one marker of SVD was associated with an increased risk of HT, while the presence of two or more markers of SVD was a potential protective factor for HT. These results indicate the need to take the total SVD score into account, not only a single SVD marker, when assessing the risk of HT. Further studies with larger samples are required to validate these findings.

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Section: Discussionsupporting

confidence: 89%

“…Although the total SVD score has been suggested to be associated with death and disability after stroke (12, 28, 29), its implications for patients with HT have yet to be investigated. Our findings provide new evidence that the total SVD score plays a non-linear role in the development of HT and its subtypes.…”

Section: Discussionmentioning

confidence: 99%

A Non-linear Association Between Total Small Vessel Disease Score and Hemorrhagic Transformation After Ischemic Stroke With Atrial Fibrillation and/or Rheumatic Heart Disease

Wei

Liu

et al. 2019

Front. Neurol.

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“…Another research that combined the results of two large cohort studies pionted out that patients with a higher total CSVD burden score had a significant increased risk of recurrent ischemic stroke and hemorrhagic transformation [ 29 ]. In consistence with the above results, our single-center study found that the total CVSD burden score was a reliable predictor for poor outcomes with a suggested CSVD score ≥ 2 [ 30 ]. We also found that the total CSVD burden score was closely related to the transformation of bleeding after thrombolysis.…”

Section: Discussionmentioning

confidence: 69%

A new nomogram for individualized prediction of the probability of hemorrhagic transformation after intravenous thrombolysis for ischemic stroke patients

Chen

Liu

et al. 2020

BMC Neurol

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Background A reliable scoring tool to detect the risk of intracerebral hemorrhage (ICH) after intravenous thrombolysis for ischemic stroke is warranted. The present study was designed to develop and validate a new nomogram for individualized prediction of the probability of hemorrhagic transformation (HT) in patients treated with intravenous (IV) recombinant tissue plasminogen activator (rt-PA). Methods We enrolled patients who suffered from acute ischemic stroke (AIS) with IV rt-PA treatment in our emergency green channel between August 2016 and July 2018. The main outcome was defined as any type of intracerebral hemorrhage according to the European Cooperative Acute Stroke Study II (ECASS II). All patients were randomly divided into two cohorts: the primary cohort and the validation cohort. On the basis of multivariate logistic model, the predictive nomogram was generated. The performance of the nomogram was evaluated by Harrell’s concordance index (C-index) and calibration plot. Results A total of 194 patients with complete data were enrolled, of whom 131 comprised the primary cohort and 63 comprised the validation cohort, with HT rate 12.2, 9.5% respectively. The score of chronic disease scale (CDS), the global burden of cerebral small vascular disease (CSVD), National Institutes of Health Stroke Scale (NIHSS) score ≥ 13, and onset-to-treatment time (OTT) ≥ 180 were detected important determinants of ICH and included to construct the nomogram. The nomogram derived from the primary cohort for HT had C- Statistics of 0.9562 and the calibration plot revealed generally fit in predicting the risk of HT. Furthermore, we made a comparison between our new nomogram and several other risk-assessed scales for HT with receiver operating characteristic (ROC) curve analysis, and the results showed the nomogram model gave an area under curve of 0.9562 (95%CI, 0.9221–0.9904, P < 0.01) greater than HAT (Hemorrhage After Thrombolysis), SEDAN (blood Sugar, Early infarct and hyper Dense cerebral artery sign on non-contrast computed tomography, Age, and NIHSS) and SPAN-100 (Stroke Prognostication using Age and NIHSS) scores. Conclusions This proposed nomogram based on the score of CDS, the global burden of CSVD, NIHSS score ≥ 13, and OTT ≥ 180 gives rise to a more accurate and more comprehensive prediction for HT in patients with ischemic stroke receiving IV rt-PA treatment.

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“…Of note, 282 studies were excluded because they were duplicates, 13,792 were excluded based on titles and abstracts, and 197 were excluded after a full-text reading revealed that the studies did not meet the inclusion criteria. Finally, for a total of 9,419 patients, 24 studies ( Derex et al, 2004 ; Kakuda et al, 2005 ; Zheng et al, 2012 ; Moriya et al, 2013 ; Dannenberg et al, 2014 ; Yan et al, 2014 , 2015a , b ; Curtze et al, 2015a , b ; Liu et al, 2017 , 2018 ; Huang, 2017 ; Xue et al, 2017 ; Chacon-Portillo et al, 2018 ; Nagaraja et al, 2018 ; Dong and Xia, 2018 ; Zhang and Zhang, 2018 ; Liu L. et al, 2019 ; Liu et al, 2019a ; Liu L. et al, 2019 ; Wen et al, 2019 ; Capuana et al, 2020 ; Zhuo et al, 2020 ) meeting the criteria were included. The selection process is shown in Figure 1 .…”

Section: Resultsmentioning

confidence: 99%

“… Forest plot showing the Impact of CSVD on HT (Liu, XY v 2019 and Liu, XY ® 2019 are from Liu et al (2019a) ; Liu, XY ¥ 2019 represents the data of LI in this study, and Liu, Y ∗ 2019 represents the data of CMB in this study). …”

Section: Resultsmentioning

confidence: 99%

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

Wang

Yan

Zhan

et al. 2021

Front. Aging Neurosci.

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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.

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The global burden of cerebral small vessel disease related to neurological deficit severity and clinical outcomes of acute ischemic stroke after IV rt-PA treatment

Cited by 30 publications

References 32 publications

A Non-linear Association Between Total Small Vessel Disease Score and Hemorrhagic Transformation After Ischemic Stroke With Atrial Fibrillation and/or Rheumatic Heart Disease

A Non-linear Association Between Total Small Vessel Disease Score and Hemorrhagic Transformation After Ischemic Stroke With Atrial Fibrillation and/or Rheumatic Heart Disease

A new nomogram for individualized prediction of the probability of hemorrhagic transformation after intravenous thrombolysis for ischemic stroke patients

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

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