Relative score of early neurological deterioration in perforator artery infarction: a retrospective study

Compared to small vessel occlusion (SVO) patients, branch atheromatous disease (BAD) patients are more likely to develop early neurological deterioration (END). Stroke patients with END have a poor prognosis. Initial clinical features/radiological findings are often insufficient to distinguish between BAD and SVO; therefore, they may not detect END. In this retrospective study, we investigated relative factors for END in perforator artery infarction and created a scoring system for END in these patients.

We extracted data from stroke patients with perforator artery infarction admitted to the Department of Neurology at Juntendo University between January 2016 and December 2022. We examined factors, such as the presence of SVO and BAD, leading to END. Variables with a P-value < 0.1 on univariate analysis were entered into binominal logistic regression analysis.

Of the 1,420 stroke patients admitted over a 7-year period, 201 with perforator infarction were included in this study. END was found in 27 of 201 patients (13.4%). Binominal logistic regression analysis of background factors less than p < 0.1 revealed that age > 69 (P = 0.032; odds ratio [OR], 3.941; 95% confidence interval [CI], 1.126–13.769), body mass index < 23.8 (P = 0.041; OR, 3.183; 95%CI, 1.049–9.654), and pretreatment with anti-platelets (P = 0.003; OR, 5.183; 95%CI, 1.783–15.071) were significant factors. Regarding anti-platelet therapy, END was observed in 34.4% of patients administered aspirin and 35.0% administered clopidogrel. Initial infarct lesion size over 15 mm on initial MRI had a P value of 0.076 in univariate analysis and an odds ratio of 1.330 (95% CI 0.471–3.755; P = 0.590) in binomial logistic regression analysis. The length of stay and modified Rankin Scale at discharge were significantly exacerbated in the END group. Creating a scoring system with 1 point for each relevant factor (pEND score), significant correlations were obtained with ROC curves, and over 2 points produced the highest sensitivity and specificity for detecting END.

Patients with high pEND scores may require intensive care from early hospitalization. In addition, the occurrence of stroke during anti-platelet therapy suggests the need for alternative treatment.