Risk Factors And Prognosis Of Patients With Acute Single Subcortical Infarction Guided By High Hesolution Magnetic Resonance Imaging

Objective To evaluate and compare Chinese Ischemic Stroke Subclassification(CISS)guide by high resolution magnetic resonance imaging(HRMRI)and Trials of Org10172 in Acute Stroke Treatment(TOAST)in making etiological diagnosis for patients with single subcortical infarctions(SSI).To detect the risk factors and clinical prognoses of large artery atherosclerosis(LAA)and penetrating artery diseases(PAD)in CISS.To detect the independent risk factors related to early neurological deterioration(END)in patients in LAA group.To find new evidences for etiological classification and secondary prevention for SSI patients.Methods From August 2017 to November 2019,a total of 150 SSI patients hospitalized into the stroke center of Northern Jiangsu People's Hospital were enrolled in our study continuously.Clinical baseline data(including age,sex,hypertension,diabetes,atrial fibrillation etc)and laboratory inspection data of these patients were collected,and the routine imaging examination and HRMRI were performed.These patients were categorized according to the criteria of TOAST and CISS,and the differences between these two classfications were compared.Furthermore,the differences in risk factors and prognoses between the two main subtypes,LAA and PAD,in CISS classification were compared.Results(1)Comparison of CISS and TOAST classifications.According to TOAST criteria,small-artery occlusion(SAO)group had the highest proportion(67 cases,44.7%),followed by LAA group(60 cases,40.0%),stroke of undetermined etiology(SUE)group(19 cases,12.7%),cardiac embolism(CE)group(3 cases,2.0%),and stroke of other determined cause(SODC)group(1 case,0.7%).Classification according to CISS standard based on HRMRI,LAA group accounted for 84 cases(56.0%),followed by PAD group(57 cases,38.0%),other etiologies(OE)group(4 cases,2.7%),undetermined etiology(UE)group(3 cases,2.0%),and cardiogenic Stroke(CS)group(2 cases,1.3%).Kappa test indicated that there were differences between corresponding subtypes of TOAST and CISS.When compared with that in TOAST classfication,the proportion of patients in LAA group increased(relative increase 40.0%,P=0.006)in CISS classfication.In addition,the proportions of patients classified as PAD and UE in CISS classfication was statistically lower(relative decreased 14.9%,P=0.241;relative decreased 84.2%,P<0.001).(2)Comparison of risk factors and prognoses of LAA and PAD groups.The risk factors and clinical prognoses of LAA and PAD groups,the two groups with highest proportions in SSI patients classfied by CISS,were analyzed in our study.Univariate analysis showed that more patients with histories of smoking(P= 0.013),high blood pressure(P=0.020),and high level of glycated hemoglobin(P= 0.039)were found in LAA group than in PAD group.A comparative analysis of the clinical prognoses of these two subtypes showed that patients in LAA group were more likely to underwent early neurological function deterioration(P=0.029).However,there was no statistical difference in the clinical prognoses at 3 months from the onset between these two subtypes(P=0.053).(3)Risk factors for END in LAA group.SSI patients in LAA group were divided into END group and non-END group.Differences in risk factors between these two groups were compared.Univariate analysis showed that the proportion of patients with previous stroke history(P=0.019),higher levels of glycated hemoglobin(P=0.025)and Lipoprotein(a)(P=0.035)in END group was higher than that in non-END group.Binary logistic regression analysis showed that high levels of glycated hemoglobin(P=0.042)and Lipoprotein(a)(P=0.038)were independent risk factors for early clinical symptom progression in LAA group of SSI patients.Conclusion(1)Inconsistency was detected between corresponding subtypes as TOAST and CISS were compared.When classfied by CISS based on HRMRI,more SSI patients were considered to get stroke because of large arterial atherosclerosis.More patients were classified into LAA group,while fewer patients were divided into UE.The etiology was evaluated more accurately which would therefore be helpful for planning rational treatment and secondary prevention strategy for SSI patients.(2)Among all the etiological groups classfied by CISS,the proportions of LAA and PAD group were relatively higher.The univariate analysis suggested that more patients in the LAA group had histories of smoking,high blood pressure,and highe levels of glycated hemoglobin when compared to the PAD group.(3)Compared with PAD group,SSI patients in LAA type were more likely to suffer from early neurological deterioration.Multivariate logistic regression analysis suggested that high level glycated hemoglobin and Lipoprotein(a)were independent predictor of early clinical symptom progression in this group.