[Concept of branch atheromatous disease (BAD) and its clinical significance].

Small deep brain infarcts are often caused by two different vascular pathologies: 1. atheromatous occlusion at the orifice of large caliber penetrating arteries termed branch atheromatous disease (BAD) and 2. lipohyallinotic degenerative changes termed lipohyalinitic degeneration (LD). Atheromatous changes at the origin or proximal portion of a penetrating artery of larger caliber can be observed in infarcts of the lenticulostriate (LSA) as well as the anterior pontine arteries (APA). We studied 392 patients with penetrating artery disease in the territories of LAS and APA to evaluate predictive factors for progressive motor deficits (PMD). Prevalence of male gender, diabetes mellitus and intracranial atherosclerosis were significantly higher in the APA group than in the LSA group. Female sex and initial severity of motor deficit were common predictors for PMD in both groups. In the LSA group, single infarcts without concomitant silent lacunar infarcts and lacunar TIAs were found to be independent predictors for PMD. In the APA group, diabetes mellitus was found to be an independent predictor. Combined treatment consisting of argatroban, cilostazol, and edaravone for acute BAD type infarct significantly improved the functional outcome.