Relationship between lesion patterns of single small infarct and early neurological deterioration in the perforating territory.

OBJECTIVE: To investigate the relationship between lesion patterns of single small infarct (SSI) in perforating territory of the vertebral-basilar artery and early neurological deterioration (end)/short-term functional outcome.

PATIENTS AND METHODS: 126 patients with acute SSI in the perforating territory of the vertebral-basilar artery, admitted within 24 h after symptom onset, were recruited between August 2010 and May 2013. The patients were divided into proximal SSI and distal SSI according to the relationship between their lesion location and their parent artery. Early neurological deterioration (END) was defined as an increase in the National Institutes of Health Stroke Scale (NIHSS) ≥ 2 within 3 days after admission. Functional outcome at 30 days after onset was assessed using the modified Rankin Score (mRS) and dichotomized as good (0-2), and poor (≥ 3).

RESULTS: Out of 126 patients, proximal SSI was found in 70 (55.56%) patients and distal SSI in 56 (44.44%) patients. After standard treatment, 36 (28.57%) patients experienced END within 3 days after admission, and 19 (15.70%) patients had a poor outcome at 30 days. Univariate analysis revealed that lesion size, baseline NIHSS score, parent artery disease, diabetes mellitus, and asymptomatic cerebral arterial atherosclerosis were significantly associated with END (with either p<005 or p<0.01), while the short-term outcome was just as significantly associated with proximal SSI, the baseline NIHSS score and END (with either p<005 or p<0.01). Results from multiple logistic regression analysis revealed that proximal SSI was an independent predictor of END (odd ratio [OR] 3.222, 95% CI 1.170-8.874, p=0.024) and that the END independently predicted a poor outcome (OR 4.126, 95% CI: 1.241-13.713, p=0.021) at 30 days after onset.

CONCLUSIONS: Proximal SSI in the perforating territory of the vertebral-basilar artery was closely related to the presence of END, and the END independently predicted the subsequent poor outcome at 30 days after onset.