Risk Factors of Neurological Deterioration in Patients with Cerebral Infarction due to Large-Artery Atherosclerosis

• Published in: Journal of stroke and cerebrovascular diseases Vol. 26; no. 8; pp. 1801 - 1806
• Main Authors: Yamamoto, Nobuaki, MD, PhD, Satomi, Junichiro, MD, PhD, Yamamoto, Yuki, MD, Shono, Kenji, MD, Kanematsu, Yasuhisa, MD, PhD, Izumi, Yuishin, MD, PhD, Nagahiro, Shinji, MD, PhD, Kaji, Ryuji, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-08-2017
• Subjects: Aged; Aged, 80 and over; Angiography, Digital Subtraction; Blood Pressure; Cardiovascular; Cerebral Angiography - methods; Cerebral Infarction - diagnostic imaging; Cerebral Infarction - etiology; Cerebral Infarction - physiopathology; Chi-Square Distribution; Diffusion Magnetic Resonance Imaging; diffusion-weighted image; Disability Evaluation; Disease Progression; Female; high blood pressure; Humans; Hypertension - complications; Hypertension - physiopathology; Intracranial Arteriosclerosis - complications; Intracranial Arteriosclerosis - diagnostic imaging; Intracranial Arteriosclerosis - physiopathology; Ischemic stroke; large-artery atherosclerosis; Logistic Models; Magnetic Resonance Angiography; Male; Middle Aged; Multivariate Analysis; neurological deterioration; Neurology; Odds Ratio; Prognosis; Retrospective Studies; Risk Assessment; Risk Factors; Severity of Illness Index; Ultrasonography, Doppler, Transcranial; large-artery atherosclerosis; diffusion-weighted image; Ischemic stroke; neurological deterioration; high blood pressure
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2017.04.011

Background In some patients with acute ischemic stroke, neurological deterioration (ND) is observed, and it is difficult to predict at the time of admission. Especially in some patients with large-artery atherosclerosis (LAA), aggressive medical treatments and surgical interventions might be helpful to prevent ND. Therefore, we investigated factors associated with ND in patients with LAA. Methods We studied patients with LAA who were admitted to our hospital. We divided them into 2 groups with (group 1) and without deterioration (group 2), and evaluated their medical records, risk factors, and radiological findings, such as number of diffusion-positive lesion and degree of stenosis. Results Our study population consisted of 171 patients; 71 (41.5%) did and 100 (58.5%) did not suffer deterioration. By univariate analysis, blood pressure (BP), heart rate, National Institutes of Health Stroke Scale (NIHSS) score, number of diffusion-positive lesion, count of red blood cell, high-density lipoprotein, and degree of stenosis differed significantly between the 2 groups. By multivariate analysis, systolic BP (≥170 mm Hg, odds ratio: 7.20, P  <   .001) was associated with ND. Furthermore, number of diffusion-weighted image (DWI)–positive lesion (≥8), degree of stenosis (>80.0%), and NIHSS score (≥4) were also independent factors associated with ND. Conclusions High BP, severity of neurological deficit at the time of admission, and radiological findings, such as degree of stenosis and number of DWI-positive lesion, are independently associated with ND in patients with LAA.