Arterial Stiffness and Progressive Neurological Deficit in Patients With Acute Deep Subcortical Infarction

• DOI: 10.1161/strokeaha.112.670737
• Publication Date: 2012-09-05T01:02:49Z
• Authors: Naoki Saji; Kazumi Kimura; Toshitaka Kawarai; Hirotaka Shimizu; Yasushi Kita
• Keywords: Brain Infarction; Male; Muscle Weakness; 3. Good health; 03 medical and health sciences; Vascular Stiffness; 0302 clinical medicine; Risk Factors; Disease Progression; Humans; Ankle Brachial Index; Female; Aged

Background and Purpose— The mechanism of progressive neurological deficit (PND) in patients with ischemic stroke remains unclear. The aim of this study was to clarify whether arterial stiffness, a marker of vascular endothelial impairment and arteriosclerosis, is associated with PND in patients with acute deep subcortical infarction.

Methods— We evaluated 156 consecutive first-ever ischemic stroke patients with acute deep subcortical infarction. PND was defined as an increment of ≥2 points in the National Institute of Health Stroke Scale score or an increase of ≥1 point in the limb weakness score within 7 days of stroke onset. Patients were assessed for risk factors, and infarct size was measured on initial diffusion-weighted magnetic resonance imaging. We measured brachial-ankle pulse wave velocity (baPWV) as a marker of arterial stiffness. We divided patients into 2 groups according to the presence or absence of PND to compare their clinical characteristics.

Results— Fifty-two patients (33%) had PND, and baPWV was significantly higher in patients with than in those without PND. The baPWV cut-off value for PND was 18.24 m/s, with 90% sensitivity and 47% specificity. In multivariable logistic regression analysis, high baPWV (≥18.24 m/s; odds ratio, 8.22; 95% confidence interval, 2.55–31.9), large infarct size (≥15 mm; odds ratio, 2.76; 95% confidence interval, 1.01–7.92), and ≥3 infarct slices on serial axial diffusion-weighted imaging (odds ratio, 3.38; 95% confidence interval, 1.22–10.0) were independently associated with PND.

Conclusions— Arterial stiffness indicated by baPWV is independently associated with PND in patients with acute deep subcortical infarction.