Clinical and Prognostic Characteristics of Acute BAD-Related Stroke: A Multicenter MRI-Based Prospective Study.

IF 7.8 1区 医学 Q1 CLINICAL NEUROLOGY Stroke Pub Date : 2024-10-01 Epub Date: 2024-09-24 DOI:10.1161/STROKEAHA.124.047688
Shengde Li, Lihua Wang, Bin Liu, Ping Zhang, Jiangtao Zhang, Guofang Chen, Qingsong Yang, Hong Bian, Xin Li, Jian Wu, Fengli Zhao, Shifu Liu, Hongying Bai, Weili Zhao, Wei Yue, Kai Feng, Yufeng Tang, Zhengqi Lu, Yusheng Li, Jingbo Zhang, Lixin Zhou, Yicheng Zhu, Jun Ni, Bin Peng
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Abstract

Background: Branch atheromatous disease (BAD)-related stroke has emerged as a meaningful subtype of ischemic stroke yet remained understudied. We aimed to investigate the demographic, clinical, therapeutic, and prognostic characteristics of BAD-related stroke.

Methods: The BAD-study was a nationwide, multicenter, prospective, observational cohort study in 20 Chinese hospitals from June 2021 to June 2023, enrolling patients aged 18 to 80 years with BAD-related stroke within 72 hours of onset. Eligible single subcortical infarct in the territory of lenticulostriate artery and paramedian pontine artery was included. Clinical, laboratory, and treatment data were collected at baseline. The primary outcome was a proportion of good outcomes (modified Rankin Scale score, 0-2) at 90 days. Main secondary outcomes included early neurological deterioration (END), cerebrovascular event, major bleeding, and excellent outcome (modified Rankin Scale score, 0-1) during 90-day follow-up.

Results: We finally enrolled 476 patients, with a median age of 60 (interquartile range, 53-68) years, and 70.2% were male. The median National Institutes of Health Stroke Scale score was 3 (interquartile range, 2-6) at enrollment. Involvement of the lenticulostriate artery was more common than the paramedian pontine artery (60.7% versus 39.3%). END occurred in 14.7% of patients, with a median time from onset of 38 (interquartile range, 22-62) hours. The rates of good and excellent outcomes were 86.5% and 72%, respectively. Its 90-day stroke recurrence rate was 1.9%. Acute-phase therapy (from onset to 7 days of enrollment) showed heterogeneity and was not associated with prognosis. Multivariable logistic regression analysis identified the National Institutes of Health Stroke Scale score ≥4 at admission and END as negative predictors and extracranial artery stenosis as a positive predictor of good outcomes. Age ≥60 years, National Institutes of Health Stroke Scale score ≥4 at admission, and END were negative predictors of excellent outcomes.

Conclusions: With distinct demographic, clinical, and prognostic characteristics, along with a high incidence of END and a low risk of stroke recurrence, BAD-related stroke could be categorized as a separate disease entity. Moreover, its acute-phase treatment strategies were undetermined, awaiting further high-quality studies.

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急性 BAD 相关脑卒中的临床和预后特征:基于磁共振成像的多中心前瞻性研究
背景:动脉粥样硬化性疾病(BAD)相关脑卒中已成为缺血性脑卒中的一个重要亚型,但研究仍然不足。我们旨在研究 BAD 相关中风的人口统计学、临床、治疗和预后特征:BAD 研究是一项全国性、多中心、前瞻性、观察性队列研究,于 2021 年 6 月至 2023 年 6 月在中国 20 家医院开展,入组年龄为 18 至 80 岁、发病 72 小时内的 BAD 相关脑卒中患者。研究对象包括符合条件的皮层下动脉和桥脑旁动脉区域的单发脑梗死患者。基线收集了临床、实验室和治疗数据。主要结果是90天后良好结果的比例(修改后的Rankin量表评分,0-2分)。主要次要结果包括早期神经功能衰退(END)、脑血管事件、大出血和90天随访期间的良好结果(改良Rankin量表评分,0-1分):我们最终招募了 476 名患者,中位年龄为 60 岁(四分位间范围为 53-68),70.2% 为男性。入院时美国国立卫生研究院卒中量表评分中位数为 3 分(四分位间范围为 2-6)。脑皮质动脉受累比脑桥旁动脉受累更常见(60.7% 对 39.3%)。14.7%的患者出现END,中位发病时间为38小时(四分位间范围为22-62小时)。良好和优秀预后率分别为 86.5% 和 72%。90 天中风复发率为 1.9%。急性期治疗(发病至入院 7 天)显示出异质性,与预后无关。多变量逻辑回归分析发现,入院时美国国立卫生研究院卒中量表评分≥4分和END是不良预后的负向预测因素,而颅外动脉狭窄是良好预后的正向预测因素。年龄≥60岁、入院时美国国立卫生研究院卒中量表评分≥4分和END是良好预后的负向预测因素:结论:BAD 相关脑卒中具有独特的人口统计学、临床和预后特征,END 发生率高,脑卒中复发风险低,可归类为一种独立的疾病实体。此外,其急性期治疗策略尚未确定,有待进一步的高质量研究。
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来源期刊
Stroke
Stroke 医学-临床神经学
CiteScore
13.40
自引率
6.00%
发文量
2021
审稿时长
3 months
期刊介绍: Stroke is a monthly publication that collates reports of clinical and basic investigation of any aspect of the cerebral circulation and its diseases. The publication covers a wide range of disciplines including anesthesiology, critical care medicine, epidemiology, internal medicine, neurology, neuro-ophthalmology, neuropathology, neuropsychology, neurosurgery, nuclear medicine, nursing, radiology, rehabilitation, speech pathology, vascular physiology, and vascular surgery. The audience of Stroke includes neurologists, basic scientists, cardiologists, vascular surgeons, internists, interventionalists, neurosurgeons, nurses, and physiatrists. Stroke is indexed in Biological Abstracts, BIOSIS, CAB Abstracts, Chemical Abstracts, CINAHL, Current Contents, Embase, MEDLINE, and Science Citation Index Expanded.
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