Distribution of atherosclerotic stenosis determining early neurologic deterioration in acute ischemic stroke

Abstract

Background and purposeEarly neurologic deterioration (END) during the acute stage of stroke is clinically important because of its association with poor outcomes. The purpose of this study was (1) to investigate variables associated with END, (2) to determine the distribution of atherosclerotic stenosis associated with END, and (3) to clarify the relationship between END and clinical outcomes.Methods516 patients with acute ischemic stroke were included. The median follow-up period was 31.7 months. END was defined as a ≥2 point increase in the National Institutes of Health Stroke Scale (NIHSS), ≥1 point increase in level of consciousness or motor item of the NIHSS, or the development of any new neurological deficits during the first 72 hours of hospitalization. A signal loss on 1.5-T magnetic resonance angiography exceeding 50% was considered to be significant for the categorization of stenosis pattern.ResultsThe prevalence of END was 19.0%. END was associated with intracranial atherosclerotic stenosis (IAS) together with large artery atherosclerosis (LAA) subtype. In particular, stenosis of basilar artery or posterior cerebral artery was independently associated with END. Lesion growth or hypoperfusion was more accountable for END in patients with IAS, whereas intracerebral hemorrhage or edema/herniation was more frequently observed in END patients without IAS. Patients with END had a higher rate of mortality, but a similar rate of further vascular events compared to patients without END.ConclusionPre-stroke IAS and LAA subtype could determine the development of END during the acute stage of ischemic stroke.

Interarm Blood Pressure Difference is Associated with Early Neurological Deterioration, Poor Short-Term Functional Outcome, and Mortality in Noncardioembolic Stroke Patients

“… 9 Cerebral artery stenosis (which is closely related to recurrent stroke), stroke progression, and END were found to be independently associated with IABD in patients with noncardioembolic stroke. 31 Our findings support the results of these previous studies; moreover, because END could produce a poor long-term prognosis in stroke patients, our results may provide additional evidence for the association between IABD and a poor long-term prognosis. Our study further suggests that bilateral brachial blood pressure measurements provide an easy screening tool for estimating the probability of END in acute noncardioembolic stroke patients.…”

Neutrophil-to-lymphocyte ratio predicts early worsening in stroke due to large vessel disease

“…Third, this positive association may depend on the underlying vascular lesions. In general, patients with ischemic stroke due to LAA mechanisms have worse early outcomes,[11, 12, 35] and the burden of stenotic lesions or stability of atherosclerotic plaques seem to have important roles. [11, 27, 35–37] Previous studies have revealed that serum NLR levels are associated with the burden of ICAS and ECAS in a dose-response manner.…”

“…Patients with ischemic stroke due to large-artery atherosclerosis (LAA) are prone to early neurological deterioration (END), and thus have worse clinical outcomes. [11, 12] In the acute phase after ischemic stroke, circulating neutrophils are immediately recruited to the ischemic areas, where they secret destructive materials (e.g., reactive oxygen species, proteases, matrix metalloproteinase-9, and cytokines) into neural tissues. [7, 13–15] At the same time, relative lymphopenia develops, partly in response to stress-induced corticosteroids, which attenuates IL-10-mediated healing process after stroke.…”

The prevalence of intracranial stenosis in patients at low and moderate risk of stroke

“…32,39 In the current study, it was worth noting that a personal history of stroke was a distinct and crucial factor that significantly increased the incidence of ICAS; correspondingly, early neurologic worsening in the phase of ischemic stroke could be determined pre-stroke by the distribution of ICAS subtype. 15,40 Consequently, a healthy lifestyle, regular physical examination and effective primary prevention measures are indispensable. 22…”