AUTHOR=Wang Yiqiao , Yan Xiaoting , Zhan Jie , Zhang Peiming , Zhang Guangming , Ge Shuqi , Wen Hao , Wang Lin , Xu Nenggui , Lu Liming 

TITLE=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

JOURNAL=Frontiers in Aging Neuroscience

VOLUME=Volume 13 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/aging-neuroscience/articles/10.3389/fnagi.2021.692942

DOI=10.3389/fnagi.2021.692942

ISSN=1663-4365

ABSTRACT=Abstract
Objective: To perform a systematic review and meta-analysis to assess whether cerebral small vessel disease (CSVD) on neuroimaging of acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT) is associated with an increased risk of hemorrhagic transformation (HT), symptomatic intracranial haemorrhage (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). Meta-analysis with fixed effects models was performed.
Results: Twenty-four eligible studies (n=9419) were pooled in the meta-analysis. All included studies were regarded as high-quality with 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 to no CSVD, the presence of CSVD was associated with an increased risk of HT (OR: 1.81, 95% CI: 1.52 to 2.16), sICH (OR: 2.42, 95% CI: 1.76 to 3.33), and 3-month PFO (OR: 2.15, 95% CI: 1.89 to 2.44). For AIS patients complicated with CSVD, compared to 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 to 5.77), sICH (OR: 2.86, 95% CI: 1.26 to 6.49) and 3-month PFO (OR: 4.58, 95% CI: 2.97 to 7.06).
Conclusions: AIS patients 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.