Abstract 3362: Neurological Deterioration And Stroke Recurrence In The Acute Phase Of Japanese Minor Stroke ∼ Fukuoka Stroke Registry ∼

Abstract

Background & Purpose: A neurological deterioration in the acute phase can be associated with a bad outcome even in the minor stroke. We investigated the predictive factors for an acute neurological deterioration in minor stroke. Subjects & Methods: Among the consecutive 3062 stroke patients who were admitted to the 7 stroke centers in Fukuoka prefecture Japan within 7 days after the onset, 2113 patients with acute ischemic stroke with the initial NIH stroke scale score of 7 or less and preclinical modified Rankin scale of 0 or 1 were included in the present study. We observed a neurological deterioration (a NIH stroke scale score worsening of ≥1-point), stroke recurrence, or any death during the first 21 hospital days. Results: A neurological deterioration with or without stroke recurrence was observed in 338 (16%) patients. Baseline NIH stroke scale score was not different between patients with and without a neurological deterioration. With regard to the TOAST classification, a neurological deterioration was most frequent in Large-artery atherosclerosis (18.3%), followed by Others (18.2%), Cardioembolism (15.6%), and Small-vessel occlusion (12.2%) in order. In accordance with the site of ischemic lesions, a neurological deterioration was most frequent in patients with both cortex or cerebellar lesions and deep perforating artery lesions (20.2%). A preexisting warfarin use was less frequent (6.8% vs 10%, p=0.0624), diabetes mellitus (42% vs 32%, p=0.0007) and a stenosis of ≥50% in the major brain artery (35% vs 28%, p=0.0133) were more frequent, and the initial values of low density lipoprotein (LDL) cholesterol (122.1±36.5 vs 116.6±34.7 mg/dl, p=0.0100), blood glucose (144.9±66.5 vs 138.9±60.1 mg/dl, p=0.0969), and HbA1c (6.05±1.42 vs 5.91±1.23, p=0.0801) were higher in patients with than without a neurological deterioration. Maximum intima-media thickness of the common carotid artery was relatively thicker in patients with than without a neurological deterioration (1.87±1.55 vs 1.69±0.97 mm, p=0.0624). On multivariate analysis, a stenosis of ≥50% in the major brain artery (OR, 1.40; 95%CI 1.07∼1.85), ischemic lesions including deep perforating artery area (OR, 1.47; 95%CI, 1.10∼1.96), LDL cholesterol (OR, 1.00; 95%CI, 1.00∼1.01), and diabetes mellitus (OR 1.70, 95%CI 1.21∼2.39) had a positive association, and preexisting warfarin use (OR 0.61, 95%CI 0.39∼0.98) had a negative association with a neurological deterioration. Conclusions: The major brain artery stenotic lesion, the site of ischemic lesions, LDL cholesterol, and diabetes mellitus were significant predictor for a neurological deterioration in the acute phase of minor stroke. A preexisting warfarin use might decrease the risk of a neurological deterioration.