Mild Luminal Stenosis of Parent Artery and Neurologic Deterioration After Acute Lacunar Stroke

 

Well congratulations, you described a problem BUT DID NOTHING TO SOLVE IT. You all need to be fired.

Mild Luminal Stenosis of Parent Artery and Neurologic Deterioration After Acute Lacunar Stroke

Dixon Yang

,

Jose Gutierrez

,

Shawna Cutting

,

Eytan Raz

,

Kursat Gurel

,

Jose Torres

,

Brian Mac Grory

,

Erica Scher

,

Sahnaz Pirooz

,

Adam de Havenon

,

Koto Ishida

,

Karen Furie

,

Mitchell S.V. Elkind

, and

Shadi Yaghi

Originally published22 Dec 2021https://doi.org/10.1161/SVIN.121.000132Stroke: Vascular and Interventional Neurology. 2021;0:e000132

Abstract

BACKGROUND

Early neurologic deterioration (END) occurs in a quarter of acute lacunar infarcts, but the underlying pathophysiological features are poorly understood. We sought to determine the association between luminal stenosis (<50%) of the parent artery and END.

METHODS

This observational study included consecutive patients with lacunar stroke from the ischemic stroke registries of New York University Langone Health and Brown University. All included patients were admitted for acute lacunar stroke, which was defined as a subcortical infarct <1.5 cm on computed tomography or <2 cm on diffusion‐weighted imaging without significant stenosis (>50%) in the parent vessel and no cardioembolic source. We defined END as any neurologic deterioration referable to the acute lacunar stroke and not related to a medical or noncerebrovascular neurological complication. We used univariate and logistic regression analyses to determine associations between luminal stenosis (<50%) and the odds of END. Furthermore, we attempted to validate findings using the Columbia University Medical Center stroke registry and perform a meta‐analysis combining the derivation and validation groups because of the expected small samples and event rates.

RESULTS

The New York University Langone Health and Brown University sample included 205 patients, of whom 41 (20%) had END. In adjusted models, we found no definite association between luminal stenosis (<50%) and END (adjusted odds ratio [OR], 1.74; 95% CI, 0.73–4.14). From Columbia University Medical Center, 361 total patients were included, of whom 59 (16%) had END. In adjusted models, we found an association between luminal stenosis (<50%) and END (adjusted OR, 2.28; 95% CI, 1.15–4.50). Meta‐analysis of both cohorts found luminal stenosis (<50%) associated with END (relative risk, 1.69; 95% CI, 1.17–2.43).

CONCLUSIONS

In this multicenter study, luminal stenosis (<50%) may be associated with END following an acute lacunar infarct. Larger studies using vessel wall imaging are needed to validate our findings.

Early neurologic deterioration (END) can occur in about a quarter of acute lacunar strokes within hours to days after initial deficit.¹ Although lacunar strokes generally have a more favorable prognosis,² END in lacunar stroke may especially involve motor function and increase risk for long‐term disability.^{3, 4} Diabetes, admission motor symptom severity, higher admission National Institutes of Health Stroke Scale, and larger lacune size have been shown to be associated with progressive deficits in lacunar stroke.^{4, 5, 6} However, the underlying pathologic mechanisms for END after lacunar stroke remain poorly understood.

Distinct from lipohyalinosis in intrinsic cerebral small‐vessel disease, Fisher and Caplan described branch atheromatous disease (BAD) as another mechanism of lacunar‐type infarcts that involves obstruction of penetrator artery orifices by atheroma of the parent vessel or microatheroma originating at the branch point.^{7, 8} END is frequently reported in lacunes with BAD, but the definition for BAD‐related lacune varied across studies and is often radiographically inferred by lacune characteristics, not direct evidence of atheroma.⁹

Therefore, a better understanding of clinical and radiographic risk factors for END in lacunar infarct may help elucidate the underlying pathophysiological features and predict patients at high risk for deterioration. In this present study, we sought to determine the association between radiographic parent vessel luminal stenosis (<50%) and END following an acute lacunar stroke.