Acute Diffusion-Weighted Imaging Lesion Patterns Predict Progressive Small Subcortical Infarct in the Perforator Territory of the Middle Cerebral Artery

Duan, Zhiqiang; Sun, Wen; Liu, Wenhua; Xiao, Lulu; Huang, Zhixin; Cao, Liping; Li, Hua; Xiong, Yunyun; Liu, Dezhi; Xu, Gelin; Liu, Xinfeng

doi:10.1111/ijs.12352

Cited by 20 publications

(33 citation statements)

References 29 publications

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“…Whereas the deterioration in the later stage of ischemic stroke was more association with systemic reasons such as aspiration, infection and electrolyte disturbances. Due to the diverse diagnostic criteria for END and the time interval to evaluation among studies, the rate of END in hospitalized ischemic stroke patients ranged from 12% to 43% [20][21][22][23]. In the present study, END was present in 32.3% of the subjects analysed, which was consistent with previous studies.…”

Section: Discussionsupporting

confidence: 90%

“…Neurological deficits assessment was performed using the National Institutes of Health Stroke Scale (NIHSS) at admission and continued at the following 72 h by a certified neurologist blind to clinical and imaging information. END was defined as the subsequent NIHSS score increasing ≥ 2 points compared with initial one [20,21].…”

Section: Treatment Protocol and Neurological Deficits Assessmentmentioning

confidence: 99%

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High-sensitive C-reactive protein and stroke outcomes in patients with and without atrial fibrillation

Tang¹,

Duan²,

Fu³

et al. 2018

biomedicalresearch

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Aims: The purpose of this study was to examine and compare the association of baseline high-sensitive C-reactive protein (hsCRP) levels with Early Neurological Deterioration (END) in acute ischemic stroke with and without Atrial Fibrillation (AF). Methods: Consecutive ischemic stroke patients admitted to our center within 24 h of symptom onset were prospectively recruited. Plasma hsCRP levels were measured after admission and categorized into three groups (low risk, <1.0 mg/L; average risk, 1-3 mg/L; and high risk, >3 mg/L). END was defined as a National Institutes of Health Stroke Scale (NIHSS) score increased ≥ 2 during the first 72 h compared with the initial NIHSS score. Results: A total of 811 patients with ischemic stroke including 348 female with average age of 66.44 ± 12.54 y were enrolled in the analysis. Of them, AF was found in 226 (27.9%) patients. During the first 72 h after admission, 81 (35.8%) patients with AF and 181 (30.9%) patients without AF developed END, respectively. After adjusting the confounding factors whose P value<0.1 in univariate analysis, multiple logistic regression analysis demonstrated that high risk level of hsCRP (OR=2.39, 95% CI: 1.06-5.40) was the independent predictors of END in AF-related stroke. However, any level of hsCRP was found to be independently related to END in patients without AF. Conclusion: Our study demonstrated that high level of hsCRP independently correlated with END in AF-related ischemic stroke.

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Section: Discussionsupporting

confidence: 90%

Section: Treatment Protocol and Neurological Deficits Assessmentmentioning

confidence: 99%

High-sensitive C-reactive protein and stroke outcomes in patients with and without atrial fibrillation

Tang¹,

Duan²,

Fu³

et al. 2018

biomedicalresearch

Self Cite

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“…1,2,7,8,10 In proximal SSI, END is believed to result from the following mechanisms related to PAD that blocks the orifice of the perforating artery: (i) stepwise progression from near occlusion to complete occlusion by plaque size growth or intra-plaque hemorrhage, (ii) rupture of an unstable plaque, or (iii) propagation of thrombus to the distal part of the perforating artery. 1,7,27 It is well-known that TG and FBS values are closely related to the instability of an atherosclerotic plaque. 28,29 IR is also one of the factors that affects the stability of a plaque.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, the anatomic relationship between SSIs and the parent artery has been noted. 1,2,7 Based on the locational relationship between them, researchers have categorized SSIs into proximal and distal SSIs. 1,2 Interestingly, proximal and distal SSIs have a different prognosis; furthermore, the underlying pathophysiologic mechanisms are also thought to differ.…”

Section: Introductionmentioning

confidence: 99%

Triglyceride-glucose index is associated with early neurological deterioration in single subcortical infarction: Early prognosis in single subcortical infarctions

Nam

Kang

Jeong

et al. 2021

International Journal of Stroke

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Background The research about the influence of triglyceride-glucose index on early prognosis in stroke is lacking. Aims In this study, we evaluated the association between triglyceride-glucose index and early neurological deterioration in patients with single subcortical infarctions. Methods Consecutive patients with single subcortical infarctions within 72 h of symptom onset between 2011 and 2015. Early neurological deterioration was defined as an increase of ≥2 in the total NIHSS score or ≥1 in the motor NIHSS score. The triglyceride-glucose index was calculated using the log scale of fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2. Results A total of 305 patients with single subcortical infarctions were evaluated. In multivariable analysis, the triglyceride-glucose index (adjusted odds ratio [aOR] = 2.94, 95% confidence interval [CI] = 1.58–5.45) and age (aOR = 1.05, 95% CI = 1.01–1.09) were associated with early neurological deterioration. In subgroup analysis according to the type of single subcortical infarctions, only patients with proximal single subcortical infarctions showed a significant association between the triglyceride-glucose index and early neurological deterioration (aOR = 2.92, 95% CI = 1.35–6.29). On the other hand, there was no statistical significance in patients with distal single subcortical infarctions. Patients with untreated diabetes also showed the close association between the triglyceride-glucose index and early neurological deterioration (aOR = 3.94, 95% CI = 1.47–10.52). Conclusions The triglyceride-glucose index was associated with early neurological deterioration in single subcortical infarctions. This association differed depending on the location of lesion and the presence of untreated diabetes.

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“…As such, patients with branch atheromatous disease have larger infarcts compared with those without branch atheromatous disease. 44 Haemodynamic failure is another proposed mechanism of neurological deterioration in patients with lacunar stroke. In one study, patients with lacunar stroke who exhibited neurological deterioration were found to have lower cerebral blood flow and increased mean transit time in the region of interest.…”

Section: Plausible Mechanismsmentioning

confidence: 99%

Lacunar stroke: mechanisms and therapeutic implications

Yaghi

Raz

Yang

et al. 2021

J Neurol Neurosurg Psychiatry

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Lacunar stroke is a marker of cerebral small vessel disease and accounts for up to 25% of ischaemic stroke. In this narrative review, we provide an overview of potential lacunar stroke mechanisms and discuss therapeutic implications based on the underlying mechanism. For this paper, we reviewed the literature from important studies (randomised trials, exploratory comparative studies and case series) on lacunar stroke patients with a focus on more recent studies highlighting mechanisms and stroke prevention strategies in patients with lacunar stroke. These studies suggest that lacunar stroke is a heterogeneous disease with various mechanisms, including most commonly lipohyalinosis and less commonly atheromatous disease and cardioembolism, highlighting the importance of a careful review of brain and neurovascular imaging, a cardiac and systemic evaluation. A better understanding of pathomechanisms of neurological deterioration may lead to investigating the utility of novel treatment strategies and optimisation of short-term antithrombotic treatment strategies to reduce the risk of neurological deterioration and prevent long-term disability in patients with lacunar stroke.

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Acute Diffusion-Weighted Imaging Lesion Patterns Predict Progressive Small Subcortical Infarct in the Perforator Territory of the Middle Cerebral Artery

Abstract: pSSSI pattern was closely related to END in acute SSSI caused by large-artery atherosclerosis and small-artery disease in the perforator territory of the MCA.

Cited by 20 publications

References 29 publications

High-sensitive C-reactive protein and stroke outcomes in patients with and without atrial fibrillation

High-sensitive C-reactive protein and stroke outcomes in patients with and without atrial fibrillation

Triglyceride-glucose index is associated with early neurological deterioration in single subcortical infarction: Early prognosis in single subcortical infarctions

Lacunar stroke: mechanisms and therapeutic implications

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