{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T08:57:59Z","timestamp":1785574679368,"version":"3.56.0"},"reference-count":41,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100001809","name":"national natural science foundation of china","doi-asserted-by":"publisher","award":["82422024"],"award-info":[{"award-number":["82422024"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Key R&D Program of Brain Science and Brain-inspired Intelligence Young Scientist Class A","award":["No. 2025ZD0215802"],"award-info":[{"award-number":["No. 2025ZD0215802"]}]},{"DOI":"10.13039\/100010002","name":"ministry of education","doi-asserted-by":"publisher","award":["JYB2025XDXM603"],"award-info":[{"award-number":["JYB2025XDXM603"]}],"id":[{"id":"10.13039\/100010002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ther Adv Neurol Disord"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Cerebral small vessel disease (CSVD) is associated with poor outcomes after endovascular thrombectomy (EVT), but the underlying mechanism remains unclear. Impaired dynamic cerebral autoregulation (dCA), a fundamental function of cerebral microvasculature, has been proposed as a potential mediator but has not been systematically investigated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To determine whether CSVD burden influences functional outcomes through alterations in dCA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Observational-cohort-study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We included 107 patients with anterior circulation large-vessel occlusion and successful EVT (expanded Thrombolysis in Cerebral Infarction \u2a7e2b). CSVD burden was assessed using standardised neuroimaging markers and dichotomised as none-to-mild (score 0\u20131) versus moderate-to-severe (score 2\u20133). dCA was assessed at two time points: early phase (T1, around 24\u2009h post-EVT) and early subacute phase (T2, around 4\u20135\u2009days post-EVT). Mediation analysis was performed to assess whether dCA changes mediated the association between CSVD burden and functional independence (modified Rankin Scale (mRS) score 0\u20132) at 90\u2009days.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Patients with moderate-to-severe CSVD (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200938) demonstrated distinct dCA recovery patterns compared with those with none-to-mild CSVD (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200969). While patients with none-to-mild CSVD exhibited improved very low frequency (VLF, 0.02\u20130.07\u2009Hz) phase differences from T1 to T2 (+7.67\u00b0 (\u22129.73, 35.53)), those with moderate-to-severe CSVD exhibited deterioration (\u22127.17\u00b0 (\u221225.03, \u22120.74),\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.004), which remained significant after multivariable adjustment (\u03b2\u2009=\u2009\u221220.06, 95% confidence interval (CI): \u221237.78 to \u22120.90,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.040). Functional independence was achieved in 73.9% of patients with none-to-mild CSVD versus 52.6% in those with moderate-to-severe CSVD (adjusted OR 0.25, 95% CI 0.09\u20130.74,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.012). Mediation analysis revealed that VLF phase changes in the affected side mediated 24.48% of the association between CSVD burden and functional outcome (average causal mediation effect: \u22127%,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001; total effect: \u221229%,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.020).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Higher CSVD burden was associated with worse functional outcomes after EVT, partially explained by impaired dCA. Patients with moderate-to-severe CSVD exhibited deteriorating dCA, whereas those with none-to-mild CSVD showed progressive improvement. Larger powerful studies are warranted to validate these findings and elucidate underlying mechanisms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration:<\/jats:title>\n                    <jats:p>ClinicalTrials.gov, NCT06361017.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17562864261470197","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T05:58:56Z","timestamp":1785391136000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Cerebral small vessel disease impairs dynamic cerebral autoregulation and mediates outcomes after stroke thrombectomy"],"prefix":"10.1177","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9114-5453","authenticated-orcid":false,"given":"Yue","family":"Qiao","sequence":"first","affiliation":[{"name":"Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ran","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Vascular Ultrasound, Xuanwu Hospital, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lupei","family":"Cai","sequence":"additional","affiliation":[{"name":"Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boyi","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siying","family":"Fan","sequence":"additional","affiliation":[{"name":"Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7994-7552","authenticated-orcid":false,"given":"Shengjun","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiameng","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Longfei","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 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