Association Between Post-Treatment Neuroimaging Markers of Cerebral Small Vessel Disease and Short-Term Efficacy of Recombinant Tissue Plasminogen Activator in Acute Stroke Patients Publisher

Summary: Do brain microbleeds affect stroke treatment response? A retrospective study linked them with poorer early response to thrombolysis, but the finding needs confirmation. #Stroke #BrainImaging

Shayganfar A ; Hajiahmadi S ; Ghaderian A ; Hemasian H ; Elhaie M
Source: Neurological Research Published:2026

Abstract

Introduction: Cerebral small vessel disease (CSVD) is prevalent in acute ischemic stroke (AIS) and may influence outcomes following intravenous thrombolysis with recombinant tissue plasminogen activator (r-tPA). This study examined associations between CSVD neuroimaging markers and early treatment response, defined as ≥4-point improvement on the National Institutes of Health Stroke Scale (NIHSS) at 24–48 hours. Methods: In this retrospective cohort study at a tertiary stroke center (August 2020–November 2021), 154 AIS patients receiving r-tPA within 4.5 hours of onset underwent MRI within 48 hours after thrombolysis.CSVD markers (cerebral microbleeds [CMBs], lacunar infarcts, white matter hyperintensities [WMHs], enlarged perivascular spaces [EPVSs]) were assessed per STRIVE-2 standards, with total CSVD burden scored 0–4. Univariate and multivariable logistic regression analyzed associations with treatment response, adjusting for baseline NIHSS, sex, dyslipidemia, and visible infarction. Results: Treatment response occurred in 70/154 patients (45.5%). CMBs were less frequent in responders (4.3%) versus non-responders (15.5%; p = 0.023). No significant differences were found for other markers or the total CSVD burden score. Multivariable analysis including baseline NIHSS confirmed that CMBs remained independently associated with reduced response (adjusted OR = 0.192; 95% CI = 0.046–0.798; p = 0.023). Dyslipidemia was more common in responders (p = 0.036). Conclusions: Among CSVD markers, only CMBs were associated with poorer early r-tPA response in AIS. Given the retrospective design, small number of CMB-positive patients, and use of post-treatment MRI, these findings should be considered hypothesis-generating. Future prospective studies with pre-treatment and serial imaging are warranted. © 2026 Informa UK Limited, trading as Taylor & Francis Group.