Lenticulostriate artery length and middle cerebral artery plaque as predictors of early neurological deterioration in single subcortical infarction

Abstract

Background: Early neurological deterioration (END) is not a rare phenomenon in single subcortical infarction (SSI; traditionally known as lacunar infarction) patients. Predictors of END in SSI patients are uncertain. Aims: We aimed to investigate the association between infarct lesion characteristics, penetrating artery morphology, carrier artery plaque features and END using whole-brain vessel-wall imaging. Methods: We prospectively collected data from SSI patients without stenosis of the corresponding carrier artery. The infarct lesion size and location, lenticulostriate artery (LSA) morphological characteristics, features of the middle cerebral artery (MCA) plaques involving M1 segment adjacent to LSA origin on the symptomatic side were compared between patients with or without END. Results: A total of 74 participants were enrolled, of whom 23 cases (31.1%) showed END. Multivariable logistic regression analysis adjusted for baseline National Institutes of Health Stroke Scale score and axial maximal diameter of infarct lesion revealed that the patients with MCA plaques adjacent to the LSA origin were more likely to develop END (odds ratio [OR] 3.87, 95% confidence interval [CI] 1.21-12.33), while with longer average length of LSAs were less likely to occur END (OR 0.21, 95% CI 0.05-0.92). Conclusions: MCA plaques located adjacent to the LSA origin and average length of LSAs on the symptomatic side were independent predictors of END in SSI patients. This finding might provide new insights into the mechanisms of the neurological progression in SSI and facilitate therapeutic interventions.

Association of compromised cerebral perfusion with lenticulostriate artery impairments in the subacute phase of branch atheromatous disease

“…32 However, previous studies including our own have suggested that it was the underlying pathogenesis rather than the size of the lesion that determined the END or prognosis in patients with SSI. 33,34 It is possible to interpret our data as supporting a link between perfusion change and CSVD-related LI, which would support Fisher's 'lacunar hypothesis'. 1,2 However, this hypothesis remains controversial, 35,36 with several studies suggesting that perfusion alteration does not play a significant role in the development of CSVD-related LI.…”

“… 32 However, previous studies including our own have suggested that it was the underlying pathogenesis rather than the size of the lesion that determined the END or prognosis in patients with SSI. 33 , 34 …”

Infarct growth velocity predicts early neurological outcomes in single subcortical infarction

“…Therefore, a slight change in IGV value may have a greater significance in distal SSI with a smaller lesion volume than in proximal SSI. Furthermore, proximal SSI occurs when the perforating artery/arteriole is occluded at the orifice level 1 , 20 , 29 . As mentioned earlier, considering that collateral flow is not developed well in these blood vessels, the occlusion of the orifice eventually causes blood supply failure to the distal area.…”

Clinical application of HALP score to predict early neurological deterioration in elderly acute cerebral infarction patients

“…However, the etiology and pathogenesis of END in AIS patients are not fully understood. Studies have con rmed that impaired lateral circulation, thrombotic enlargement, cerebral edema, and hemorrhagic transformation are associated with END [6][7][8] , and that immune in ammation plays an important role in these pathophysiology.…”