Intracranial Atherosclerosis Is Associated with Progression of Neurological Deficit in Subcortical Stroke

Abstract

Background: Progression of neurological deficit (PND) is a frequent complication of acute subcortical ischemic stroke (SCS). The role of intracranial atherosclerosis (IAS) in PND is controversial. Our goal was to evaluate IAS on admission, as predictor of PND in SCS patients. Methods: SCS patients were identified from our prospective database from 2004 to 2008. Clinical and laboratory data were collected from charts, and radiographic data from original radiographs. The proximal intracranial arteries were graded as patent, irregular, stenotic, or occlusion. IAS was defined as irregularity or stenosis. PND was defined as a change in the National Institutes of Health Stroke Scale >1 point. Results: Two hundred and two SCS patients were identified. In 14%, PND occurred at a median of 2 days from onset. Univariate analysis by infarct location showed the following to be associated with PND: for anterior circulation infarcts (centrum semiovale/basal ganglia), M1 atherosclerosis (p = 0.042); for posterior circulation infarcts, vertebral artery atherosclerosis (p = 0.018). For both groups, we found a non-significant association with age (p = 0.2) and HbA1c levels (p = 0.095). No association was found with admission glucose levels. Multivariate analysis showed the following association with PND: for anterior circulation infarcts, M1 atherosclerosis (OR 4.7; 95% CI 1.2–18.8; p = 0.03); for pontine infarcts, vertebral artery atherosclerosis (OR 5.8; 95% CI 1.1–29.4; p = 0.033). There was an increase in PND likelihood with an increasing number of atherosclerotic vessels. Discussion: In our cohort of SCS patients, PND was associated with IAS of the responsible vessels. These results suggest a role for IAS in the pathogenesis of PNF in SCS patients.

Hypercoagulation on Thromboelastography Predicts Early Neurological Deterioration in Patients with Acute Ischemic Stroke

“…By comparison, patients with END corresponded to a higher proportion of females (45.8 vs. 18.4%, p < 0.001), higher rates of DM history (38.9 vs. 20.1%, p = 0.015), higher baseline NIHSS score (5 [3][4][5][6][7][8][9] vs. 2 [1][2][3][4], p = 0.001), and higher serum high-sensitivity C-reactive protein (hsCRP) levels (5.60 [2.46-7.14] vs. 1.65 [0.70-4.68], p = 0.002). In the comparison of TEG parameters, patients in the END group had a significantly shorter reaction time R (4.0 ± 1.0 vs. 4.7 ± 1.2 min, p < 0.001) and kinetic time K (1.3 ± 0.4 vs. 1.5 ± 0.4 min, p = 0.003) than patients without END.…”

“…Early neurological deterioration (END) occurs in approximately 20-30% of patients following acute ischemic stroke and poses a major challenge for clinicians, as it is consistently associated with increased post-stroke depen-DOI: 10.1159/000492729 dency and in-hospital mortality [1][2][3]. Although some risk factors have been identified in previous studies, END remains insidious and largely unpredictable in clinical practice.…”

Single Subcortical Infarction and Atherosclerotic Plaques in the Middle Cerebral Artery

“…Perhaps, a plaque that is located close to the orifice of the branching arteries gives rise to a microembolism or hypoperfusion in the relevant subcortical tissue, leading to unfavorable clinical outcomes. 19 Our study has a merit in that consecutive patients with SSI were prospectively enrolled and thoroughly assessed by DWI, MR angiogram, and HR-MRI. The limitations of this study were the number of patients was relatively small and the M2 portion of the MCA was not examined by HR-MRI.…”

The augmentation index as a useful indicator for predicting early symptom progression in patients with acute lacunar and atherothrombotic strokes

“…Therefore, one patient who continued antihypertensive therapy was excluded. Finally, 147 cases (79 males, median age 74 [IQR 64-82] years, and NIHSS score 3 [1][2][3][4][5][6][7]) were enrolled in the present study. When evaluating only cases with lacunar (n = 53) and atherothrombotic strokes (n = 23) using the TOAST classification Table 2 shows the relationship between the AIx and stroke etiology or atherosclerotic risk factors adjusted for age, sex, and height.…”

“…Although it has been suggested that some factors, such as intracranial atherosclerosis [4], lacunar stroke [5], location of the infarct lesion [6], infarct size [7], diabetes mellitus [8], and initial high blood glucose level [9], correlate with symptom worsening, the mechanisms and predictors of the deterioration are not well known.…”