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

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.