Abstract W P91: The Presence of Asymptomatic Lacune Predicts Stroke Progression after Acute Cerebral Infarction

Abstract

Background: The prediction of stroke progression after acute cerebral infarction is important for clinician to determine high risk patient group for close observation and proactive management. We sought to find imaging biomarker which predicts neurological deterioration after acute cerebral infarction. Methods: Between January 2008 and June 2013, those acute infarction patients who admitted Chung-Ang university hospital within seven days after symptom onset were eligible to be included. We selected the patients who had been through both brain CT angiography and brain MR imaging (MRI) including susceptibility weighted image and FLAIR. The presence of white matter hyperintensity, asymptomatic lacune, and cerebral microbleed were assessed from initial brain MRI, and intracranial vascular calcification was analyzed from both intracranial internal carotid arteries by brain CT angiography. Stroke progression was defined as two or more National Institutes of Health Stroke Scale progression during admission. Univariate analysis followed by multivariate logistic regression analysis was performed to find independent imaging parameter which predicts stroke progression. Results: A total of 724 patients were included in the study period. Univariate analysis showed that severe calcification involving both distal internal carotid artery more than 1 centimeter and/or 50% of vessel diameter (p=0.006), white matter hyperintensity with Fazekas grade 3 (p=0.007), and asymptomatic lacune (p=0.013) is associated with stroke progression. Multivariate logistic regression analysis adjusted with age>70 years, gender, atrial fibrillation smoking, and high sensitive C-reactive protein disclosed that asymptomatic lacune is an independent predictor of stroke progression after acute cerebral infarction (odds ratio=1.76, confidence interval=1.03-3.02 p-value=0.039). Conclusion: Our study showed that the presence of asymptomatic lacune is an independent imaging biomarker associated with neurological deterioration after cerebral infarction.