AUTHOR=Long Xiaoyue , Tian Haozhi , Yang Xiao , Zhang Fangfang , Chen Yan , Wen Yingye , Dong Zhong , Li Xia , Zhang Peilan 

TITLE=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

JOURNAL=Frontiers in Neurology

VOLUME=Volume 16 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2025.1645980

DOI=10.3389/fneur.2025.1645980

ISSN=1664-2295

ABSTRACT=BackgroundSmall vessel disease (SVD) has been linked to adverse outcomes after acute ischemic stroke (AIS), but existing studies often rely on post-treatment imaging or single SVD markers, limiting pre-therapeutic risk assessment. Furthermore, most studies have not accounted for infarct location (defined as the brain region affected by the AIS event)–particularly failing to focus on regions highly vulnerable to SVD, such as the basal ganglia or corona radiata. To address these gaps, this study utilized pretreatment multimodal magnetic resonance imaging (MRI) to comprehensively assess SVD burden and its individual markers in patients with a single AIS lesion in one of these regions (i.e., basal ganglia or corona radiata) who underwent intravenous thrombolysis (IVT), aiming to improve pre-treatment individualized outcome prediction following IVT.MethodsThis study recruited patients admitted to Tianjin Huanhu Hospital between August 2023 and January 2025 who presented within 4.5 h of stroke symptom onset. The SVD burden was calculated by analyzing MRI data and quantified using a validated 0–4 point scale, which incorporated the assessment of four established MRI markers: white matter hyperintensities (WMH), lacunar infarcts (LI), cerebral microbleeds (CMBs), and enlarged perivascular spaces (EPVS). The primary outcomes were defined as follows: ① early neurological deterioration (END), operationalized as an increase of ≥ 4 points in the National Institutes of Health Stroke Scale (NIHSS) score within 24 h after thrombolysis; and ② poor functional outcome, defined as a modified Rankin Scale (mRS) score > 2 at 90 days post-onset, indicating moderate-to-severe disability. Secondary outcomes included symptomatic intracranial hemorrhage (sICH) and malignant cerebral edema (MCE) occurring within 24 h after IVT. Subsequently, multivariable logistic regression models were employed, with adjustment for potential confounding factors, to evaluate SVD burden and each individual SVD subtype separately against clinical outcomes after IVT; subtypes were not entered simultaneously in the same model. Furthermore, To evaluate the independence of each SVD marker in the presence of co-existing lesions, a comprehensive model was further constructed with all SVD markers entered simultaneously. This fully adjusted analysis allowed us to identify which markers retained significance after mutual adjustment.ResultsA total of 346 patients who met the inclusion criteria were enrolled in the study (mean age: 62.88 ± 10.21 years; 70.8% male). Based on the SVD scoring system described in the Methods, patients were categorized into two groups: the absent-to-mild SVD group, exibiting a score of 0–1 (n = 207, 60%) and the moderate-to-severe SVD group, exibiting a score ≥ 2 (n = 139, 40%). Compared with Absent-to-Mild SVD, Moderate-to-Severe SVD was significantly associated with increased 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). Further subtype analysis revealed that CMBs were most strongly linked to an elevated risk of sICH (OR = 6.080, 95% CI: 1.834–20.156). In contrast, deep white matter hyperintensities (DWMHs) independently predicted END (OR = 2. 187, 95% CI: 1.343–3.560), mRS > 2 (OR = 1.620, 95% CI: 1.093–2.400), and sICH (OR = 1.763, 95% CI: 1.057–2.942). However, in a fully adjusted model including all SVD markers, CMBs remained significantly associated with sICH (OR = 5.353, 95% CI: 1.400–20.471), whereas associations for other markers were no longer statistically significant.ConclusionThese findings suggest that pre-treatment SVD burden and specific markers—particularly CMBs and DWMHs—may serve as independent predictors of adverse outcomes following IVT in patient patients with basal ganglia or corona radiata infarcts. Furthermore, When all SVD markers are adjusted for simultaneously, only CMBs remained significantly associated with sICH. If validated in prospective studies, the incorporation of rapid, non-invasive SVD assessment into routine pre-IVT imaging protocols could enable more refined individualized risk stratification, supporting informed, patient-centered decision-making regarding treatment risks and benefits while affirming IVT's overall net clinical benefit.