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Multiple hypointense vessels on susceptibility-weighted imaging predict early neurological deterioration in acute ischaemic stroke patients with severe intracranial large artery stenosis or occlusion receiving intravenous thrombolysis
  1. Yong-Lin Liu1,
  2. Han-Peng Yin1,
  3. Dong-Hai Qiu1,
  4. Jian-Feng Qu1,
  5. Huo-Hua Zhong1,
  6. Zhi-Hao Lu1,
  7. Fang Wang2,
  8. Man-Qiu Liang2,
  9. Yang-Kun Chen1
  1. 1Department of Neurology, Dongguan People’s Hospital, Dongguan, Guangdong, China
  2. 2Department of Radiology, Dongguan People’s Hospital, Dongguan, Guangdong, China
  1. Correspondence to Dr Yang-Kun Chen; cykun78{at}


Background and purpose Early neurological deterioration (END) is a common feature in patients with acute ischaemic stroke (AIS) receiving thrombolysis. This study aimed to investigate whether the presence of multiple hypointense vessels (MHVs) on susceptibility-weighted imaging (SWI) could predict END in patients with the anterior circulation AIS treated with recombinant tissue plasminogen activator (r-tPA).

Methods This was a retrospective study focusing on AIS patients suffering from symptomatic stenosis or occlusion of the middle cerebral artery or internal carotid artery with r-tPA treatment. We collected clinical variables and initial haematological and neuroimaging findings. MHVs were measured on SWI performed after intravenous thrombosis and were defined as the presence of a greater number of veins or veins of a larger diameter with greater signal loss on SWI than those of the contralesional haemisphere. The degree of hyperintensity of MHVs was classified into four grades: none, subtle, moderate and extensive. END was defined as an increase in the National Institutes of Health Stroke Scale score by 2 points during the first 48 hours after the onset of symptoms. Multivariate logistic regressions were conducted to investigate the predictors of END.

Results The study included 61 patients (51 males and 10 females) with a mean age of 62.4±12.6 years. Thirty-five (57.4%) patients presented with MHVs: 8 (13.1%) were graded as subtle MHVs, while 23 (37.7%) and 4 (6.6%) were graded as moderate or extensive MHVs, respectively. Twenty patients (32.8%) presented with END. Logistic regression analysis showed that compared with patients without MHVs, moderate MHVs (adjusted OR 5.446, 95% CI 1.360 to 21.800; p=0.017) and extensive MHVs (adjusted OR 15.240, 95% CI 1.200 to 193.544; p=0.036) were significantly associated with END.

Conclusions MHVs might be a useful predictor of END in AIS patients with symptomatic large artery stenosis or occlusion after r-tPA treatment.

  • stroke
  • MRI

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  • Contributors Y-LL: designed and conceptualised the study; analysed the data; data acquisition; drafted the manuscript for intellectual content. Y-KC: designed and conceptualised study; analysed the data; data acquisition; revised the manuscript for intellectual content. H-PY, D-HQ, J-FQ, H-HZ, Z-HL, FW, M-QL: analysed data; data acquisition.

  • Funding This study was supported by the Medical Scientific Research Foundation of Guangdong Province, China (Reference number: A2018322).

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval This study was approved by the hospital ethics committee (approval number: KYKT2018-002).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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