Keon-Joo Lee1,2, Keun-Hwa Jung3,4, Chan-Young Park1,2, Jeong-Min Kim5, Soon-Tae Lee1,2, Kon Chu1,2, Manho Kim1,2, Sang Kun Lee1,2, Jae-Kyu Roh6. 1. Department of Neurology, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, 101, Daehangno, Jongno-gu, Seoul, 03080, South Korea. 2. Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea. 3. Department of Neurology, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, 101, Daehangno, Jongno-gu, Seoul, 03080, South Korea. jungkh@gmail.com. 4. Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea. jungkh@gmail.com. 5. Department of Neurology, Chung-Ang University Medical Center, College of Medicine, Chung-Ang University, Seoul, South Korea. 6. Department of Neurology, The Armed Forces Capital Hospital, Seongnam, South Korea.
Abstract
OBJECTIVE: We investigated the association of clinical, laboratory, sonographic and imaging parameters, in the progression of single subcortical infarctions. METHODS: Consecutive 169 patients with lacunar (n = 89) and striatocapsular infarctions (n = 80) in the middle cerebral artery (MCA) territory with nonstenotic MCAs were recruited and examined for stroke progression. The pulsatility index (PI) was measured by transcranial Doppler from ipsilateral M1. RESULTS: The striatocapsular infarction group exhibited more stroke progression. The patients with progressive lacunar infarctions had more diabetes, higher HbA1c levels, and higher initial National Institutes of Health Stroke Scale (NIHSS) scores, and the patients with progressive striatocapsular infarctions had more hypertension, higher cholesterol levels, and higher NIHSS scores. The MCA PI was higher in the lacunar infarction patients with progression (0.99 ± 0.19 vs. 0.90 ± 0.14, p = 0.048), while the striatocapsular infarction patients did not differ according to progression. From a multivariate analysis, higher MCA PI were independently associated with lacunar infarction progression (by 0.1 increase, OR 1.51; 95 % CI 1.06-2.15; p = 0.024). CONCLUSIONS: Higher pulsatility was associated with progression in lacunar infarction. PI measured by transcranial Doppler sonography might reflect downstream arterial resistance and vascular/paravascular perfusion status and be a possible indicator of stroke progression. KEY POINTS: • Higher pulsatility index was observed in progression group of lacunar infarction patients. • Higher pulsatility index seemed to be associated with progression in lacunar infarction patients. • Differences in the factors associated with stroke progression suggest different underlying pathophysiologies.
OBJECTIVE: We investigated the association of clinical, laboratory, sonographic and imaging parameters, in the progression of single subcortical infarctions. METHODS: Consecutive 169 patients with lacunar (n = 89) and striatocapsular infarctions (n = 80) in the middle cerebral artery (MCA) territory with nonstenotic MCAs were recruited and examined for stroke progression. The pulsatility index (PI) was measured by transcranial Doppler from ipsilateral M1. RESULTS: The striatocapsular infarction group exhibited more stroke progression. The patients with progressive lacunar infarctions had more diabetes, higher HbA1c levels, and higher initial National Institutes of Health Stroke Scale (NIHSS) scores, and the patients with progressive striatocapsular infarctions had more hypertension, higher cholesterol levels, and higher NIHSS scores. The MCA PI was higher in the lacunar infarctionpatients with progression (0.99 ± 0.19 vs. 0.90 ± 0.14, p = 0.048), while the striatocapsular infarctionpatients did not differ according to progression. From a multivariate analysis, higher MCA PI were independently associated with lacunar infarction progression (by 0.1 increase, OR 1.51; 95 % CI 1.06-2.15; p = 0.024). CONCLUSIONS: Higher pulsatility was associated with progression in lacunar infarction. PI measured by transcranial Doppler sonography might reflect downstream arterial resistance and vascular/paravascular perfusion status and be a possible indicator of stroke progression. KEY POINTS: • Higher pulsatility index was observed in progression group of lacunar infarctionpatients. • Higher pulsatility index seemed to be associated with progression in lacunar infarctionpatients. • Differences in the factors associated with stroke progression suggest different underlying pathophysiologies.
Authors: S Nannoni; A Del Bene; V Palumbo; L Petrone; F Sottile; G Pracucci; D Inzitari Journal: Acta Neurol Scand Date: 2015-03-24 Impact factor: 3.209
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