Abstract Body:
Background and Purpose Whether imaging markers of cerebral small vessel disease on computed tomography (CT-CSVD) relates to early clinical outcomes after intravenous thrombolysis for acute ischemic stroke remains not well understood. This multicenter retrospective study aims to investigate the association between baseline CT-CSVD score and early clinical outcomes in acute ischemic stroke patients who received intravenous thrombolysis.

Methods Individual CT-CSVD imaging markers and total score were assessed based on the following conditions: severe white matter lucencies (grade 2), two or more lacunes, and severe central or cortical atrophy (grade 2), with scores ranging from 0 to 3. The primary outcome was functional independence, defined as a modified Rankin Scale score of 0-2 at discharge. The secondary outcome was early neurological deterioration, defined as a 2-point or greater decline on the NIHSS within the first 24h of admission. Multivariate logistic regression analyses were used to examine the associations between CT-CSVD scores and outcomes.

Results Of 920 eligible patients (median age 68, male 65.8%), 9.9% (91/920) experienced early neurological deterioration, and 62.1% (545/877) achieved functional independence at discharge. Patients with increasing CT-CSVD scores were older (p<0.001), more likely to have hypertension (p<0.001), diabetes (p<0.001), coronary artery disease (p=0.044), and a higher baseline systolic blood pressure (p=0.037). Multivariable logistic regression analyses showed increasing CT-CSVD score was associated with reducing odds of functional independence (categorical variable, vs. score 0, score 1: OR 0.68, 95%CI 0.46-1.02; score 2: OR 0.46, 95%CI 0.26-0.83; score 3: OR 0.16, 95%CI 0.03-0.76, overall p for trend = 0.007; per point increase, OR 0.65, 95%CI 0.51-0.83, p < 0.001) and increasing risk of early neurological deterioration (categorical variable, vs. score 0, score 1: OR 1.28, 95%CI 0.74-2.21; score 2: OR 1.69, 95%CI 0.81-3.52; score 3: OR 6.92, 95%CI 1.63-29.32; p for trend= 0.047; per point increase, OR 1.44, 95%CI 1.06-1.95, p = 0.019).

Conclusion This observational study showed that sum cerebral small vessel disease score on computed tomography was associated with a lower odds of functional independence and a higher risk of early neurological deterioration after intravenous thrombolysis for acute ischemic stroke.