Cerebral Small Vessel Disease and Outcomes in Patients With Acute Ischemic Stroke Receiving Endovascular Treatment: A Systematic Review and Meta‐Analysis

Abstract

Background It remains unclear whether neuroimaging markers of cerebral small‐vessel disease (CSVD) affect the outcomes of patients with acute ischemic stroke receiving endovascular treatment (EVT). The aim of this systematic review and meta‐analysis was to evaluate the association between CSVD neuroimaging markers and outcomes in patients with acute ischemic stroke undergoing EVT. Methods We conducted a systematic search of PubMed and EMBASE databases up to July 2022 using keywords or Medical Subject Heading terms (“cerebral small‐vessel diseases,” “leukoaraiosis,” “microbleed,” “enlarged perivascular space,” “recent small subcortical infarct,” “atrophy,” “lacune,” and “thrombectomy”). The assessed clinical outcomes were a good functional outcome, 90‐day mortality, symptomatic intracranial hemorrhage, and early neurologic improvement after EVT. Results Overall, 30 studies on patients with acute ischemic stroke undergoing EVT were included. Patients with absent or mild white matter hyperintensities had higher good functional outcomes (odds ratio [OR], 2.94 [95% CI, 2.44–3.53]; P<0.001) and lower mortality rate (OR, 0.42 [95% CI, 0.11–1.59]; P<0.001), whereas the presence of cerebral microbleeds increased only the risk of 90‐day mortality (OR, 0.60 [95% CI, 0.44–0.83]; P=0.002). Moreover, patients with moderate/severe CSVD burden had worse functional outcomes than those with none/mild CSVD burden (OR, 2.94 [95% CI, 2.44–3.53]; P<0.001), but neither mortality nor symptomatic intracranial hemorrhage was significantly different between the 2 groups. Conclusions The existence of CSVD affected the outcomes of patients with acute ischemic stroke receiving EVT. Future multicenter prospective cohort studies with little heterogeneity should be prioritized to confirm our results.