Correlation Between Cerebral Atherosclerotic Stenosis And Early Neurologic Deterioration In Patients With Acute Ischemic Stroke

ObjectiveTo analyze the risk factors of early neurological deterioration(END)and the correlation between the distribution of cerebral atherosclerotic stenosis and early neurologic deterioration in acute atherosclerotic stroke,so as to better guide clinical treatment.Methods371 ischemic stroke patients with cerebral atherosclerotic stenosis were included.END was defined as 2 point increase in the National Institutes of Health Stroke Scale(NIHSS),1 point increase in level of consciousness or motor item of the NIHSS,or the development of any new neurological deficits during the first 72 hours of hospitalization.According to occurrence of early neurologic deterioration,the patients were divided into END group and non-END group.According to distribution of cerebral atherosclerotic stenosis detected by head and neck computerized tomography angiography,magnetic resonance angiography or digital subtraction angiography,arterial stenosis was defined as ?50% stenosis,the patients were divided into single artery stenosis and multiple artery stenosis group.The baseline data of age,hypertension,diabetes and distribution of different cerebral atherosclerotic stenosis were analyzed by univariate analysis.Multivariable logistic regression analysis was used to analyze the risk factors for END after acute ischemic stroke(P<0.05).Result1.371 patients with cerebral atherosclerotic stenosis were included in acuteischemic stroke,92 patients had END,and the incidence of early neurological deterioration was 24.8%.2.In the single factor baseline data study,compared with the non-END group,age73.5±7.5vs65.8±10.9),hypertension(85.9%vs73.5%),diabetes(48.9%vs29.0%),admission Systolic pressure(165.7±19.3vs152.9±23.5),NIHSS(10.4±4.9vs4.6±4.1),initial stroke severity were increased.Multivariable Logistic regression analysis showed that age [OR=1.063,95%CI:1.028-1.100;P<0.001],diabetes[OR=2.330,95%C I:1.262-4.300,P=0.007],NIHSS [OR=1.355,95%CI:1.170-1.569,P<0.001],moderate stroke[OR=10.792,95%CI:1.182-98.492,P=0.035],Severe stroke[OR=7.744,95%CI:1.838-32.626,P=0.005] were the independent risk factor for END.3.The incidence of END was different in single artery stenosis group: anterior cerebral artery(2.3%),middle cerebral artery(54.4%),posterior cerebral artery(9.1%),basilar artery(4.5%),intracranial internal carotid artery(11.4%),intracranial vertebral artery(6.8%),extracranial internal carotid artery(6.8%),extracranial vertebral artery(4.5%).Compared with the patients in the non-END group,the middle cerebral artery group[54.5%(24/44)vs21.2%(28/132);P<0.001]was increased significantly in the END group,and the anterior cerebral artery group[2.3%(1/44)vs12.9%(17/132);P=0.044] and posterior cerebral artery[9.1%(4/44)vs22.7%(30/132);P=0.047]were decreased significantly in the END group.Logistic regression analysis showed that middle cerebral artery stenosis[OR=1.805,95%:1.217-2.676,P=0.003] was the independent risk factor for END.4.The incidence of END was significant difference in the multiple artery stenosis group.The multiple intracranial artery stenosis group(66.7%)was the most common,followed by the intracranial and extracranial artery stenosis group(29.2%),the multiple extracranial artery stenosis group least(4.2%).Compared with the patients in the non-END group,the multiple intracranial artery stenosis group [ 66.7%(32/48)vs47.6%(70/147);P = 0.022]were increased significantly in the END group.Conclusion1.Age,diabetes,initial NIHSS,moderate and severe stroke were independent risk factors for END in clinical baseline materials.2.The distribution of cerebral atherosclerotic stenosis is related to early neurologic deterioration.In particular,the middle cerebral artery stenosis was the independent risk factor for END in single artery stenosis group.3.The multiple intracranial artery stenosis was the most common in the multiple artery stenosis group.