EARLY NEUROLOGICAL DETERIORATION IN LACUNAR STROKE: CLINICAL AND IMAGING PREDICTORS AND ASSOCIATION WITH LONG-TERM OUTCOME (ID 228)
- Jan Vynckier (Belgium)
- Thomas R. Meinel (Switzerland)
- Basel Maamari (Switzerland)
- Lorenz Grunder (Switzerland)
- Martina B. Goeldlin (Switzerland)
- Johannes Kaesmacher (Switzerland)
- Arsany Hakim (Switzerland)
- Marcel Arnold (Switzerland)
- Jan Gralla (Switzerland)
- David J. Seiffge (Switzerland)
- Urs Fischer (Switzerland)
Abstract
Background And Aims
Objective. To determine the rate and predictors of early neurological deterioration (END) in patients with lacunar strokes as well as its implications for management and outcome.
Methods
We enrolled consecutive patients with MRI-defined lacunar stroke who presented within 12 hours after symptom onset from a prospective stroke database (2015-2019). END was defined as any persisting increase in National Institutes of Health Stroke Scale (NIHSS) score of ≥2 points within 24 hours after admission and favorable outcome as modified Rankin Scale (mRS) of 0-2 at 90 days. We assessed the association of END with clinical and imaging variables, acute treatment and outcome using multivariable regression, calculating adjusted odds ratios.
Results
Sixty-one of 365 (16.7%) patients with acute lacunar stroke (median age 71.8 years, 39.5% female, median NIHSS score on admission 3) had END. Lower NIHSS score on admission (per point, aOR 0.81, p=0.006), capsular warning syndrome (aOR 7.00, p<0.001), ventral pontine infarct (aOR 3.49, p=0.008) and hypoperfusion on imaging (aOR 2.13, p=0.026) were associated with END. Acute dual antiplatelet therapy was associated with reduced risk of END (aOR 0.10, p=0.04). Patients with END had less favorable outcome at 90 days (aOR 0.13 p<0.001), but intravenous thrombolysis (IVT) was associated with favorable outcome at 90 days (aOR 3.95, p=0.002).
Conclusions
One in six patients with lacunar stroke has END and patients at high risk of END can be identified using radiological and clinical variables. Targeted therapeutic trials for this population seem justified.
