Short-term Functional Outcomes and Treatment Trends between Branch Atheromatous Disease and Lacunar Infarction: Retrospective Cohort Study of the Nationwide Multicenter Registry.

Background: Branch atheromatous disease (BAD) is a form of ischemic stroke that presents with imaging findings similar to those of lacunar infarction, but has a different pathogenesis and is known to cause progressive paralysis. Due to regional variations, the epidemiology of BAD is not wellunderstood, and its relationship with functional prognosis remains unclear. Using a comprehensive Japanese stroke database, we investigated its epidemiological characteristics and associations with functional outcomes.

Methods: In this multicenter cohort study, we retrospectively analyzed data from the Saiseikai Stroke Database (2013-2021) including 27 hospitals. We used multivariable logistic regression to calculate adjusted odds ratios (ORs) with 95% confidence intervals (CIs) of BAD compared with LI for functional outcomes at discharge. Ischemic stroke caused by BAD or LI was included and demographic characteristics and clinical data were evaluated and contrasted between BAD and LI.

Results: Of the 5,966 analyzed patients, 1,549 (25.9%) had BAD and 4,434 (74.1%) had LI. BAD was associated with worse functional outcomes (adjusted OR of 2.77, 95%CI: 2.42-3.17, relative to LI) and extended hospital stays (median 19 days for BAD vs. 13 days for LI). Moreover, aggressive treatment strategies, including the use of argatroban and dual antiplatelet therapy, were more common in BAD patients.

Conclusions: BAD presented worse functional outcomes and longer hospital stays than LI, necessitating treatment plans that take into account its progression and prognosis.