Redefining Infarction Size for Small-Vessel Occlusion in Acute Ischemic Stroke: A Retrospective Case-Control Study.

IF 3.2 Q2 CLINICAL NEUROLOGY Neurology International Pub Date : 2024-10-21 DOI:10.3390/neurolint16050088
Yen-Chu Huang, Hsu-Huei Weng, Leng-Chieh Lin, Jiann-Der Lee, Jen-Tsung Yang, Yuan-Hsiung Tsai, Chao-Hui Chen
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Abstract

Background/objectives: Small-vessel occlusion, previously referred to as lacunar infarcts, accounts for approximately one-third of all ischemic strokes, using an axial diameter of less than 20 mm on diffusion-weighted imaging. However, this threshold may not adequately differentiate small-vessel occlusion from other pathologies, such as branch atheromatous disease (BAD) and embolism. This study aimed to assess the clinical significance and pathological implications of acute small subcortical infarctions (SSIs) based on infarct diameter.

Methods: We conducted a retrospective case-control study using data from stroke patients recorded between 2016 and 2021 of the Stroke Registry in Chang Gung Healthcare System. Patients with acute SSIs in penetrating artery territories were included. Key variables such as patient demographics, stroke severity, and medical history were collected. Infarcts were categorized based on size, and the presence of early neurological deterioration (END) and favorable functional outcomes were assessed.

Results: Among the 855 patients with acute SSIs, the median age was 70 years and the median National Institutes of Health Stroke Scale (NIHSS) score at arrival was four. END occurred in 97 patients (11.3%). Those who experienced END were significantly less likely to achieve a favorable functional outcome compared to those who did not (18.6% vs. 59.9%, p < 0.001). The incidence of END increased progressively with infarct sizes of 15 mm or larger, with the optimal threshold for predicting END identified as 15.5 mm and for BAD, it was 12.1 mm. A multiple logistic regression analysis revealed that motor tract involvement [adjusted odds ratio (aOR) 2.3; 95% confidence interval (CI) 1.1-4.7], an initial heart rate greater than 90 beats per minute (aOR 2.3; 95% CI 1.2-4.3), and a larger infarct size (15 mm to less than 20 mm vs. 10 mm to less than 15 mm; aOR 3.0; 95% CI 1.4-6.3) were significantly associated with END.

Conclusions: Our findings suggest that setting the upper limit for small-vessel occlusion at 15 mm would be more effective in distinguishing it from BAD. However, these findings should be interpreted in the context of the retrospective design and study population. Further multi-center research utilizing high-resolution vessel wall imaging is necessary to refine this threshold and enhance diagnostic accuracy.

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重新定义急性缺血性卒中小血管闭塞的梗死规模:一项回顾性病例对照研究。
背景/目的:小血管闭塞(以前称为腔隙性脑梗塞)约占所有缺血性脑卒中的三分之一,其弥散加权成像的轴向直径小于 20 毫米。然而,这一阈值可能无法充分区分小血管闭塞和其他病变,如动脉粥样硬化分支疾病(BAD)和栓塞。本研究旨在根据梗死直径评估急性小皮层下梗死(SSI)的临床意义和病理影响:我们利用长庚医疗系统卒中登记处在 2016 年至 2021 年期间记录的卒中患者数据进行了一项回顾性病例对照研究。研究纳入了穿透性动脉区域急性 SSI 患者。研究收集了患者的人口统计学特征、中风严重程度和病史等关键变量。根据梗塞的大小进行分类,并评估是否存在早期神经功能恶化(END)和良好的功能预后:在 855 名急性 SSI 患者中,年龄中位数为 70 岁,抵达时美国国立卫生研究院卒中量表(NIHSS)评分中位数为 4 分。97名患者(11.3%)发生了END。与未发生END的患者相比,发生END的患者获得良好功能预后的可能性明显较低(18.6% vs. 59.9%,P < 0.001)。END的发生率随着梗死面积达到或超过15毫米而逐渐增加,预测END的最佳阈值为15.5毫米,而预测BAD的最佳阈值为12.1毫米。多元逻辑回归分析显示,运动束受累[调整后比值比(aOR)2.3;95% 置信区间(CI)1.1-4.7]、初始心率大于 90 次/分(aOR 2.3;95% CI 1.2-4.3)和梗死面积较大(15 毫米至小于 20 毫米 vs. 10 毫米至小于 15 毫米;aOR 3.0;95% CI 1.4-6.3)与END显著相关:我们的研究结果表明,将小血管闭塞的上限设定为 15 毫米将更有效地将其与 BAD 区分开来。但是,在解释这些发现时应考虑到回顾性设计和研究人群。有必要利用高分辨率血管壁成像技术进一步开展多中心研究,以完善这一阈值并提高诊断准确性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Neurology International
Neurology International CLINICAL NEUROLOGY-
CiteScore
3.70
自引率
3.30%
发文量
69
审稿时长
11 weeks
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