ORIGINAL RESEARCH article
Front. Neurol.
Sec. Applied Neuroimaging
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1645980
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
Provisionally accepted
Xiaoyue Long1,2
Haozhi Tian1,2Xiao Yang3Fangfang Zhang1Yan Chen1Yingye Wen1Zhong Dong1
Li Xia1,2Peilan Zhang1,2*- 1Tianjin Huanhu Hospital, Tianjin, China
- 2Tianjin Medical University, Tianjin, China
- 3The Second Hospital of Tianjin Medical University, Tianjin, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
This study investigated the impact of pretreatment small vessel disease (SVD) burden on outcomes in acute ischemic stroke (AIS) patients with infarcts in SVD-vulnerable regions (basal ganglia or corona radiata) undergoing intravenous thrombolysis (IVT). We enrolled 346 patients from Tianjin Huanhu Hospital (August 2023–January 2025) within 4.5 hours of onset. Pretreatment MRI assessed SVD burden using a validated 0–4 scale based on white matter hyperintensities (WMH), lacunar infarcts, cerebral microbleeds (CMBs), and enlarged perivascular spaces. Patients were categorized as absent-to-mild (0–1) or moderate-to-severe (≥2) SVD. Primary outcomes were early neurological deterioration (END; NIHSS increase ≥4 within 24 hours) and poor functional outcome (mRS >2 at 90 days); secondary outcomes included symptomatic intracranial hemorrhage (sICH) and malignant cerebral edema within 24 hours. Multivariable logistic regression models were sequentially adjusted for individual SVD markers. Of the patients (mean age 62.88 ± 10.21 years; 70.8% male), 139 (40%) had moderate-to-severe SVD. This group had higher 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). Deep WMHs independently predicted END, poor outcome, and sICH in marker-specific models. CMBs showed the strongest association with sICH (OR = 6.080, 95% CI: 1.834–20.156), and remained significant after full adjustment (OR = 5.353, 95% CI: 1.400–20.471). Other markers lost significance when mutually adjusted. In conclusion, higher pretreatment SVD burden predicts adverse outcomes post-IVT in patients with basal ganglia or corona radiata infarcts. While deep WMHs and CMBs are key predictors, only CMBs independently predict sICH after full adjustment. Rapid, multimodal MRI-based SVD assessment may improve pre-therapeutic risk stratification and support individualized IVT decisions. Prospective validation is warranted.
Keywords: Acute ischemic stroke, intravenous thrombolysis, Neurological function, Multimodal magnetic resonance imaging, cerebral small vesseldisease
Received: 29 Jul 2025; Accepted: 10 Oct 2025.
Copyright: © 2025 Long, Tian, Yang, Zhang, Chen, Wen, Dong, Xia and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Peilan Zhang, peilanzhng@sina.com
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.