Association of MRI markers of cerebral small vessel disease and ischemic stroke recurrence in patients treated with intravenous thrombolysis: A three-year prospective cohort study

Background and Objectives: It remains unclear whether the total cerebral small vessel diseases (CSVD) burden can predict risk of recurrent ischemic stroke in patients treated with intravenous thrombolysis (IVT). We aim to investigate the association between the total CSVD burden and recurrent ischemic stroke in patients treated with IVT. Methods We enrolled patients with acute ischemic stroke (AIS) undergoing IVT between September 2017 and June 2019. According to the total burden rating scale of CSVD on MRI, we calculated the total CSVD burden score. Study participants were followed up regularly by two neurologists at 3,6,12,24 and 36 months after the index AIS onset. We used Kaplan–Meier survival curves and Cox proportional hazards regression models to attempt to prove the associations between the total CSVD burden and recurrent ischemic stroke. Results We found that recurrent ischemic stroke events in patients treated with IVT were associated with total CSVD burden, higher cumulative incidence rates of recurrent stroke were more common in higher CSVD score (log-rank P ≤ 0.001). In multivariate Cox regression analysis, diabetes (adjusted HR = 4.065,95%CI = 2.143–7.713, P = 0.000), secondary prevention (adjusted HR = 0.322,95%CI = 0.150–0.691, P = 0.004), and the total CSVD score of 3 point (adjusted HR = 4.907,95%CI = 1.017–23.678, P = 0.048), 4 point (adjusted HR = 13.480,95%CI = 2.587–70.245, P = 0.002) were independently associated with recurrent ischemic strokes within 3 years. However, the total CSVD score of 1 point (adjusted HR = 1.524,95%CI = 0.313–7.412, P = 0.602), 2 point (adjusted HR = 3.111,95%CI = 0.668–14.495, P = 0.148) were not associated with recurrent ischemic stroke. Increasing CSVD score was also associated with all-cause mortality and ischemic stroke events mortality during follow-up in patients treated with IVT. Conclusions Total CSVD burden was associated with recurrent ischemic stroke in patients treated with IVT. Most notably the total CSVD score of 3 or 4 resulted in a more than 4-fold increase in risk of recurrent ischemic stroke in patients treated with IVT.