Influencing Factors Of Stroke Severity And Early Neurological Deterioration In Patients With Acute Posterior Circulation Infarction

ObjectiveEarly Neurological Deterioration(END)is one of the common complications of acute ischemic stroke,which can lead to poor long-term prognosis.We analyzed the influencing factors of stroke severity and END in patients with Acute Posterior Circulation Infarction(APCI).and hoped to provide some references for the early treatment of APCI.MethodsWe constantly recruited patients with APCI diagnosed by magnetic resonance diffusion-weighted imaging(DWI)within 72 hours of onset.The severity of stroke was assessed usinp the National Institutes of Health Stroke Scale(NIHSS).Patients with APCI were divided into the minor stroke group and the non-minor stroke group according to the NIHSS score at admission,and END was observed.The distribution of infarct lesions were referred to Caplan standard:We divided the posterior circulation into proximal,middle,and distal intracranial territories.The degree of extracranial ve(?)ebral artery stenosis was assessed bv vascular ultrasound.Magnetic Resonance Angiography(MRA)was used to assess the degree of stenosis of the intracranial vertebral artery,basilar artery,and posterior cerebral artery and the presence of fetal-type posterior cerebral artery.The demographic data,vascular risk factors.etiological classification,infarction distribution and posterior circulation vascular status were compared between the minor stroke group and the non-minor stroke group.END patients and non-END patients.We analyzed the influencing factors of stroke(?)y and END in patients with APCI.Results1.297 patients with APCI were recruited,including 204 males(68.69%)and 93 females(31.31%)with an average age of(66.281±11.05)years.The most common etiological classification was small-artery occlusion in 119 cases(40.07%).followed by stroke of undetermined etiology in 100 cases(33.67%).large-artery atherosclerosis in 62 cases(20.88%),and cardioembolism in 16 cases(5.39%).2.There were 236 patients(79.46%)in the minor stroke group and 61 patients(20.54%)in the non-minor stroke group.Compared with the non-minor stroke group,the proportion of previous history of stroke(30.51%vs.47.54%.P=0.012).infarction in middle segment territories(53.39%vs.81.97%.P=0.000).basilar artery stenosis(14.41%vs.34.43%,P=0.000)and posterior cerebral artery stenosis(13.98%vs.31.15%,P=0.002)were lower in the minor stroke group.Compared with the non-minor stroke group,the proportion of small-artery occlusion(45.34%vs.19.67%,P=0.000).fetal-type posterior cerebral artery(19.49%vs.8.20%,P=0.037)were higher in the minor stroke group.Multivariate logistic regression analysis showed that compared with the non-minor stroke group,the proportion of small-artery occlusion(OR=3.02,95%Cl:1.34-6.78,P=0.008)and fetal-type posterior cerebral artery(OR=3.11.95%Cl:1.11-8.73.P=0.031)were significantly higher in the minor stroke group.And compared with the non-minor stroke group,the incidence of infarction in middle segment territories(OR=0.25,95%CI:0.12-0.54,P=0.000)was significantly lower in the minor stroke group.3.There were patients(11.11%)with END and 264 patients(88.89%)with non-END.Compared with patients with non-END.the proportion of females(48.48%vs.29.17%.P=0.024).NIHSS score at admission(5.00 vs.3.00.P=0.000).infarction in middle segment territories(87.88%vs.55.68%),P=0.000),vertebral arteny stenosis(48.48%vs.30.30%.P=0.035),basilar artery stenosis(39.39%vs.15.91%,P=0.001)and posterior cerebral artery stenosis(36.36%vs.15.15%,P=0.003)were higher in patients with END.Multivariate logistic regression analysis showed that compared with patients with non-END,the proportion of females(OR=2.48,95%CI:1.12-5.46,P=0.024)and infarction in middle segment territories(OR=4,44,95%Cl:1.45-13.62,P=0.009)were significantly higher in patients with END.Conclusion1.APCI patients with lesions in middle segment territories had a heavier stroke severity and were more likely to END.2.In APCI.the incidence of small-artery occlusion in patients with minor stroke was higher than that with non-minor stroke.3,In APCI.the proportion of fetal-type posterior cerebral artery in patients with minor stroke was higher than that with non-minor stroke.