Abstract 3984: Neurological Deterioration And Stroke Recurrence In The Acute Phase Of Ischemic Stroke In The Deep Perforating Artery Territory ∼ 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 or stroke recurrence in the deep perforating artery territory 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, 1141 patients with infarcts supplied by deep perforating artery 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 196 (17.2%) patients. Baseline NIH stroke scale score was not different between patients with and without a neurological deterioration (2.7±1.9 vs 2.7±1.7). With regard to the TOAST classification, a neurological deterioration was most frequent in Large-artery atherosclerosis (27.8%), and was least frequent in Small-vessel occlusion (12.3%). The site of ischemic lesions was not associated with a neurological deterioration. A preexisting warfarin use was less frequent (7% vs 11%, p=0.0472), dyslipidemia (62% vs 53%, p=0.0182) and a stenosis of ≥50% in the major brain artery (26% vs 16%, p=0.0009) were more frequent, the values of low density lipoprotein (LDL) cholesterol was higher (124.6±36.3 vs 119.4±33.8 mg/dl, p=0.0495) and high density lipoprotein (HDL) was lower (50.7±14.1 vs 53.8±14.4 mg/dl, p=0.0056) in patients with than without a neurological deterioration. Diabetes mellitus was relatively more frequent in patients with than without a neurological deterioration (43% vs 36%, p=0.0669). On multivariate analysis, a stenosis of ≥50% in the major brain artery (OR, 2.44; 95%CI 1.44∼4.17) had a positive association with a neurological deterioration. Initial HDL values (OR, 0.99; 95%CI, 0.97∼1.00) and preexisting warfarin use (OR, 0.38; 95%CI, 0.13∼1.11) tended to be negatively associated with a neurological deterioration. Conclusions: The major brain artery stenotic lesion was a significant predictor for an acute neurological deterioration or stroke recurrence in the deep perforating artery territory stroke. A preexisting warfarin use and high HDL value might decrease the risk of a neurological deterioration.