Large Arterial Stenosis Is Associated With Early Neurological Deterioration In Acute Ischemic Stroke

Background:According to previous studies, early neurological deterioration (END), defined as consistently or staged clinical neuro-functional deterioration in A the first s everal hours or days and could ultimately lead to unfavorable outcome, occurred in ap proximately one third of patients with ischemic stroke despite standard treatment. Due to the limited knowledge on the nosogenesis of END, there is no effective treatment t o date. The study on the clinical predictors of END, thereby, is getting more critical. Although some previous studies showed that female, blood pressure and glucose coul d be related to END, there remains no reliable indicator to distinguish high-risk patien ts because of the inconsistent times windows and analysis between each studies. Furth ermore, some previous studies demonstrated credible relationship between artery stem stenosis and unsatisfied prognosis. But it is unknown that whether artery stem stenosi s could be related to END in early phrase of ischemic stroke. Our study was aimed to retrospectively investigate the clinical and imaging risk factors of END, in order to cla rify the clinical value of artery stem lesion in predicting END.Objective:To evaluate the relationship between the cerebrocervical artery stenosis/occlusion and early neurological deterioration (END) in patients with acute ischemic stroke in the territory of middle cerebral artery.Methods:Two hundreds and fifty-six patients with acute ischemic stroke were retrospective recruited between January,2012 and December,2013 and divided into END group and non-END group according to the dynamic National Institutes of Health Stroke Scale (NIHSS) during the first 72h after admission. The status of responsible artery was graded as normal or mild stenosis (<50%), moderate stenosis (50%-70%), severe stenosis (71%-99%) and occlusion (100%). Clinical risk factors, initial stroke severity, lesion diameter and responsible artery status were analyzed between group with END and group without END.Results:Of the 256 patients,70 (27.34%) patients experienced END. Univariate analysis indicated that age (P=0.045), lesion diameter (P=0.045), NIHSS score (P=0.007) at admission, and the status of responsible artery (P=0.038) were significantly associated with the presence of END. After adjustment for the confounding factors, responsible artery with severe stenosis (OR 2.521,95% CI 1.079-5.886, P= 0.033) or occlusive disease (OR 3.074,95% CI 1.262-7.489, P= 0.013) was the independent risk factors of END.Conclusion:Severe stenosis and occlusive artery disease were closely related to the presence of END. An early arterial study, therefore, might be helpful in selecting patients with high risk of END after acute ischemic stroke.