BMC Neurology (Aug 2024)

Relative score of early neurological deterioration in perforator artery infarction: a retrospective study

  • Kazo Kanazawa,
  • Nobukazu Miyamoto,
  • Kenichiro Hira,
  • Chikage Kijima,
  • Nobutaka Hattori

DOI
https://doi.org/10.1186/s12883-024-03807-9
Journal volume & issue
Vol. 24, no. 1
pp. 1 – 9

Abstract

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Abstract Background and aims Compared to small vessel occlusion (SVO) patients, branch atheromatous disease (BAD) patients are more likely to develop early neurological deterioration (END). Stroke patients with END have a poor prognosis. Initial clinical features/radiological findings are often insufficient to distinguish between BAD and SVO; therefore, they may not detect END. In this retrospective study, we investigated relative factors for END in perforator artery infarction and created a scoring system for END in these patients. Methods We extracted data from stroke patients with perforator artery infarction admitted to the Department of Neurology at Juntendo University between January 2016 and December 2022. We examined factors, such as the presence of SVO and BAD, leading to END. Variables with a P-value 69 (P = 0.032; odds ratio [OR], 3.941; 95% confidence interval [CI], 1.126–13.769), body mass index < 23.8 (P = 0.041; OR, 3.183; 95%CI, 1.049–9.654), and pretreatment with anti-platelets (P = 0.003; OR, 5.183; 95%CI, 1.783–15.071) were significant factors. Regarding anti-platelet therapy, END was observed in 34.4% of patients administered aspirin and 35.0% administered clopidogrel. Initial infarct lesion size over 15 mm on initial MRI had a P value of 0.076 in univariate analysis and an odds ratio of 1.330 (95% CI 0.471–3.755; P = 0.590) in binomial logistic regression analysis. The length of stay and modified Rankin Scale at discharge were significantly exacerbated in the END group. Creating a scoring system with 1 point for each relevant factor (pEND score), significant correlations were obtained with ROC curves, and over 2 points produced the highest sensitivity and specificity for detecting END. Conclusion Patients with high pEND scores may require intensive care from early hospitalization. In addition, the occurrence of stroke during anti-platelet therapy suggests the need for alternative treatment.

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