Enlarged perivascular spaces and clinical outcome of acute ischemic stroke patients receiving intravenous thrombolysis

J Stroke Cerebrovasc Dis. 2025 Jul;34(7):108342. doi: 10.1016/j.jstrokecerebrovasdis.2025.108342. Epub 2025 May 7.

Abstract

Background: Enlarged perivascular spaces (EPVS) is one of the main imaging features of cerebral small vessel disease (CSVD). Previous studies have shown that hypertension and advanced age were important risk factors for the occurrence and development of EPVS. We aim to explore the correlation between the severity of EPVS at centrum semiovale and basal ganglia and the early and long-term outcome of acute ischemic stroke (AIS) patients receiving intravenous thrombolysis.

Methods: AIS who received intravenous thrombolysis at the First Affiliated Hospital of Kunming Medical University were retrospectively collected. Demographic data, stroke risk factors, laboratory test results and head imaging data were collected. The number of EPVS in centrum semiovale and basal ganglia of patients in cranial magnetic resonance imaging (MRI) was counted by visual quantification method. Logistic regression analysis was used to evaluate the independent risk factors affecting the prognosis.

Results: A total of 196 subjects were included in this study. The proportion of patients with poor clinical outcome at 90 days was higher in patients with moderate-to-severe centrum semiovale EPVS than in those with no-to-mild EPVS (42.9 % vs 18.7 %, P=0.031). Similarly, patients with moderate-to-severe EPVS in the basal ganglia region had a significantly poor clinical outcome at 90 days (51.7 % vs 18.3 %, P=0.001). Moderate to severe basal ganglia EPVS (OR=2.661, 95 %CI: 1.070-6.618, P=0.035), hyperlipidemia (OR=3.011, 95 %CI: 1.147-7.902, P=0.025) and a higher baseline NIHSS score before thrombolysis (OR=1.194, 95 %CI: 1.071-1.331, P=0.001) were independent risk factors for poor clinical outcome at 90 days. Early neurological improvement (OR=0.220, 95 %CI 0.093-0.520, P=0.001) was associated with a reduced risk of poor clinical outcomes at 90 days.

Conclusions: Moderate-to-severe EPVS in basal ganglia were an independent risk factor for poor clinical outcome at 90 days in AIS patients with intravenous thrombolysis. Therefore, the severity of EPVS in the basal ganglia region can serve as an imaging marker to predict the 90-day clinical outcome of AIS patients treated with intravenous thrombolysis.

Keywords: Acute ischemic stroke; Basal ganglia; Centrum semiovale; Clinical outcome; Enlarged perivascular space; Intravenous thrombolysis.

MeSH terms

  • Administration, Intravenous
  • Aged
  • Aged, 80 and over
  • Basal Ganglia* / diagnostic imaging
  • Cerebral Small Vessel Diseases* / diagnostic imaging
  • Female
  • Fibrinolytic Agents* / administration & dosage
  • Fibrinolytic Agents* / adverse effects
  • Glymphatic System* / diagnostic imaging
  • Humans
  • Ischemic Stroke* / diagnostic imaging
  • Ischemic Stroke* / drug therapy
  • Ischemic Stroke* / physiopathology
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Recovery of Function
  • Retrospective Studies
  • Risk Factors
  • Severity of Illness Index
  • Thrombolytic Therapy* / adverse effects
  • Time Factors
  • Treatment Outcome

Substances

  • Fibrinolytic Agents