Impact of total cerebral small vessel disease burden on infarction growth rate and clinical outcomes in acute anterior circulation large vessel occlusion

doi:10.3877/cma.j.issn.1673-9248.2025.02.009

Abstract

Abstract:

Objective

To investigate the impact of total cerebral small vessel disease (CSVD)burden on infarction growth rate (IGR) and clinical outcomes in patients with acute anterior circulation large vessel occlusion undergoing endovascular therapy (EVT).

Methods

This retrospective study included 198 patients with acute anterior circulation large vessel occlusion who underwent EVT with successful recanalization at Suqian First People’s Hospital between January 2021 and December 2023.Based on modified Rankin scale (mRS) scores at 90 days, patients were divided into a favorable outcome group (mRS: 0-2,n=104) and a poor outcome group (mRS: 3-6, n=94).Clinical data, including age, baseline National Institutes of Health stroke scale (NIHSS) score, and IGR calculated from pre-operative CT perfusion imaging, were collected.Total CSVD burden was graded using brain MRI (0-1: mild; 2: moderate; 3-4: severe).Collateral circulation was assessed using the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) collateral grading scale on digital subtraction angiography(DSA).Multivariate logistic regression was performed to identify risk factors for poor outcomes.Receiver operating characteristic (ROC) curves evaluated the predictive value of IGR for poor outcomes.Patients were further stratified into fast-IGR (≥9.78 mL/h) and slow-IGR groups based on the optimal IGR cutoff.

Results

Compared to the favorable outcome group, the poor outcome group exhibited significantly higher age, baseline NIHSS score, IGR, and CSVD burden, and lower ASITN/SIR scores (all P＜0.001).Multivariate analysis identified age, baseline NIHSS score, ASITN/SIR score, IGR, and moderate-to-severe CSVD as independent risk factors for 90-day poor outcomes.ROC analysis showed an area under the curve (AUC)of 0.813 (95% CI: 0.738-0.905, P＜0.001) for IGR in predicting poor outcomes, with an optimal cutoff of 9.78 mL/h.Fast-IGR patients had higher baseline NIHSS scores and CSVD burden, and lower ASITN/SIR scores(all P＜0.001).Multivariate logistic regression identified NIHSS score, ASITN/SIR score, and moderate-tosevere CSVD were independent risk factors for fast IGR (P＜0.05).

Conclusion

Increased CSVD burden is associated with impaired collateral circulation, accelerated IGR, and worse clinical outcomes.Total CSVD burden may serve as a biomarker for predicting tissue injury progression and clinical prognosis after EVT in acute anterior circulation large vessel occlusion.

Key words: Total cerebral small vessel disease burden, Infarct growth rate, Stroke, Endovascular therapy, Futile recanalization

Hu Huang, Chunjie Song, Zhiwei Liu, Xing Chen, Fayong Zhu, Yuanyuan Han. Impact of total cerebral small vessel disease burden on infarction growth rate and clinical outcomes in acute anterior circulation large vessel occlusion[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2025, 19(02): 141-148.

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URL: https://zhnxgbzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1673-9248.2025.02.009

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Figures/Tables 6

基线资料	预后良好（104 例）	预后不良（94 例）	统计值	P值
年龄（岁， $\overset{ˉ}{x}$ ± s ）	66.8±10.2	69.0±11.6	t=2.285	0.012
男性[ 例（%）]	67（64.4）	59（62.8）	χ ²=0.059	0.809
高血压病[ 例（%）]	60（57.7）	50（53.2）	χ ²=0.405	0.524
2 型糖尿病[ 例（%）]	36（34.6）	35（37.2）	χ ²=0.147	0.701
冠心病[ 例（%）]	29（27.9）	28（29.8）	χ ²=0.087	0.768
高脂血症[ 例（%）]	24（23.1）	24（25.5）	χ ²=0.162	0.687
吸烟史[ 例（%）]	42（40.4）	41（43.6）	χ ²=0.212	0.645
房颤[ 例（%）]	16（15.4）	23（24.5）	χ ²=2.576	0.109
收缩压（mmHg， $\overset{ˉ}{x}$ ± s ）	153.2±11.9	155.8±10. 2	t=1.416	0.263
舒张压（mmHg， $\overset{ˉ}{x}$ ± s ）	88.9±9.4	91.6±11.1	t=1.373	0.314
基线NIHSS 评分[ 分，M（Q_R）]	11.5（8.0，15.0）	14.5（9.0，17.0）	Z=3.879	＜0.001
FPG[mmol/L，M（Q_R）]	6.7（5.2，8.4）	7.4（5.5，8.9）	Z=2.527	0.011
ALT[U/L，M（Q_R）]	28（21，40）	31（22，38）	Z=0.457	0.672
AST[U/L，M（Q_R）]	31（22，39）	28（19，42）	Z=0.816	0.853
尿素氮（mmol/L， $\overset{ˉ}{x}$ ± s ）	5.67±2.13	6.04±1.96	t=1.257	0.337
Cr（μmol/L， $\overset{ˉ}{x}$ ± s ）	68.62±12.57	69.82±11.38	t=1.152	0.474
TC（mmol/L， $\overset{ˉ}{x}$ ± s ）	4.42±1.53	4.64±1.44	t=0.997	0.682
TG（mmol/L， $\overset{ˉ}{x}$ ± s ）	1.48±0.76	1.68±0.82	t=0.826	0.769
LDL-C（mmol/L， $\overset{ˉ}{x}$ ± s ）	2.75±0.88	2.89±1.03	t=1.882	0.587
HDL-C（mmol/L， $\overset{ˉ}{x}$ ± s ）	1.21±0.57	1.14±0.72	t=1.940	0.479
ASITN/SIR 评分[ 分，M（Q_R）]	3（2，3）	2（1，3）	Z=4.173	＜0.001
IGR（ml/h， $\overset{ˉ}{x}$ ± s ）	5.42±3.84	11.07±4.62	t=3.712	＜0.001
CSVD 总负荷[ 例（%）]			χ ²=13.455	＜0.001
轻度	67（64.4）	39（41.5）
中度	31（28.8）	37（39.4）
重度	6（5.8）	18（19.1）

基线资料	预后良好（104 例）	预后不良（94 例）	统计值	P值
年龄（岁， $\overset{ˉ}{x}$ ± s ）	66.8±10.2	69.0±11.6	t=2.285	0.012
男性[ 例（%）]	67（64.4）	59（62.8）	χ ²=0.059	0.809
高血压病[ 例（%）]	60（57.7）	50（53.2）	χ ²=0.405	0.524
2 型糖尿病[ 例（%）]	36（34.6）	35（37.2）	χ ²=0.147	0.701
冠心病[ 例（%）]	29（27.9）	28（29.8）	χ ²=0.087	0.768
高脂血症[ 例（%）]	24（23.1）	24（25.5）	χ ²=0.162	0.687
吸烟史[ 例（%）]	42（40.4）	41（43.6）	χ ²=0.212	0.645
房颤[ 例（%）]	16（15.4）	23（24.5）	χ ²=2.576	0.109
收缩压（mmHg， $\overset{ˉ}{x}$ ± s ）	153.2±11.9	155.8±10. 2	t=1.416	0.263
舒张压（mmHg， $\overset{ˉ}{x}$ ± s ）	88.9±9.4	91.6±11.1	t=1.373	0.314
基线NIHSS 评分[ 分，M（Q_R）]	11.5（8.0，15.0）	14.5（9.0，17.0）	Z=3.879	＜0.001
FPG[mmol/L，M（Q_R）]	6.7（5.2，8.4）	7.4（5.5，8.9）	Z=2.527	0.011
ALT[U/L，M（Q_R）]	28（21，40）	31（22，38）	Z=0.457	0.672
AST[U/L，M（Q_R）]	31（22，39）	28（19，42）	Z=0.816	0.853
尿素氮（mmol/L， $\overset{ˉ}{x}$ ± s ）	5.67±2.13	6.04±1.96	t=1.257	0.337
Cr（μmol/L， $\overset{ˉ}{x}$ ± s ）	68.62±12.57	69.82±11.38	t=1.152	0.474
TC（mmol/L， $\overset{ˉ}{x}$ ± s ）	4.42±1.53	4.64±1.44	t=0.997	0.682
TG（mmol/L， $\overset{ˉ}{x}$ ± s ）	1.48±0.76	1.68±0.82	t=0.826	0.769
LDL-C（mmol/L， $\overset{ˉ}{x}$ ± s ）	2.75±0.88	2.89±1.03	t=1.882	0.587
HDL-C（mmol/L， $\overset{ˉ}{x}$ ± s ）	1.21±0.57	1.14±0.72	t=1.940	0.479
ASITN/SIR 评分[ 分，M（Q_R）]	3（2，3）	2（1，3）	Z=4.173	＜0.001
IGR（ml/h， $\overset{ˉ}{x}$ ± s ）	5.42±3.84	11.07±4.62	t=3.712	＜0.001
CSVD 总负荷[ 例（%）]			χ ²=13.455	＜0.001
轻度	67（64.4）	39（41.5）
中度	31（28.8）	37（39.4）
重度	6（5.8）	18（19.1）

变量	B 值	SE 值	Wald 值	OR 值（95%CI）	P值
年龄	0.198	0.096	5.672	1.516（1.120～1.973）	0.002
基线NIHSS 评分	0.517	0.168	9.462	1.696（1.145～2.368）	＜0.001
ASITN/SIR 评分	0.674	0.052	7.542	3.271（2.313～4.528）	＜0.001
IGR	0.126	0.037	16.382	5.762（4.328～8.673）	＜0.001
CSVD 总负荷
中度	0.686	0.127	6.385	3.017（1.582～5.524）	＜0.001
重度	0.169	0.054	13.285	8.481（5.773～11.752）	＜0.001

观察指标	慢IGR（116 例）	快IGR（82 例）	统计值	P值
年龄（岁， $\overset{ˉ}{x}$ ± s ）	67.9±11.7	68.8±8.9	t=1.528	0.253
男性[ 例（%）]	75（64.7）	51（62.2）	χ ²=0.126	0.723
高血压病[ 例（%）]	61（52.6）	49（59.8）	χ ²=1.000	0.317
2 型糖尿病[ 例（%）]	41（35.3）	30（36.6）	χ ²=0.032	0.858
冠心病[ 例（%）]	31（26.7）	26（31.7）	χ ²=0.582	0.446
高脂血症[ 例（%）]	26（22.4）	22（26.8）	χ ²=0.510	0.475
吸烟史[ 例（%）]	46（39.7）	37（45.1）	χ ²=0.590	0.443
收缩压（mmHg， $\overset{ˉ}{x}$ ± s ）	151.2±11.3	154.8±9.6	t=1.097	0.682
舒张压（mmHg， $\overset{ˉ}{x}$ ± s ）	88.7±9.1	92.6±7.3	t=0.945	0.723
基线NIHSS 评分[ 分，M（Q_R）]	10.5（8.0，13.0）	15.5（10.0，17.0）	Z=4.257	＜0.001
ASITN/SIR 评分[ 分，M（Q_R）]	3（2，3）	2（1，3）	Z=3.468	＜0.001
CSVD 总负荷[ 例（%）]			χ ²=15.612	＜0.001
轻度	75（64.7）	31（37.8）
中度	33（28.4）	35（42.7）
重度	8（6.9）	16（19.5）

观察指标	慢IGR（116 例）	快IGR（82 例）	统计值	P值
年龄（岁， $\overset{ˉ}{x}$ ± s ）	67.9±11.7	68.8±8.9	t=1.528	0.253
男性[ 例（%）]	75（64.7）	51（62.2）	χ ²=0.126	0.723
高血压病[ 例（%）]	61（52.6）	49（59.8）	χ ²=1.000	0.317
2 型糖尿病[ 例（%）]	41（35.3）	30（36.6）	χ ²=0.032	0.858
冠心病[ 例（%）]	31（26.7）	26（31.7）	χ ²=0.582	0.446
高脂血症[ 例（%）]	26（22.4）	22（26.8）	χ ²=0.510	0.475
吸烟史[ 例（%）]	46（39.7）	37（45.1）	χ ²=0.590	0.443
收缩压（mmHg， $\overset{ˉ}{x}$ ± s ）	151.2±11.3	154.8±9.6	t=1.097	0.682
舒张压（mmHg， $\overset{ˉ}{x}$ ± s ）	88.7±9.1	92.6±7.3	t=0.945	0.723
基线NIHSS 评分[ 分，M（Q_R）]	10.5（8.0，13.0）	15.5（10.0，17.0）	Z=4.257	＜0.001
ASITN/SIR 评分[ 分，M（Q_R）]	3（2，3）	2（1，3）	Z=3.468	＜0.001
CSVD 总负荷[ 例（%）]			χ ²=15.612	＜0.001
轻度	75（64.7）	31（37.8）
中度	33（28.4）	35（42.7）
重度	8（6.9）	16（19.5）

变量	B 值	SE 值	Wald 值	OR 值（95%CI）	P值
基线NIHSS 评分	0.167	0.052	5.828	1.794（1.237～2.438）	0.011
ASITN/SIR 评分	0.462	0.153	11.027	5.369（3.281～7.152）	＜0.001
CSVD 总负荷
中度	0.306	0.172	8.667	3.268（1.872～4.686）	＜0.001
重度	0.169	0.041	16.385	9.027（6.042～13.369）	＜0.001

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