Steno-occlusive arterial disease and early neurological deterioration in acute ischemic stroke.
OBJECTIVE
To evaluate the influence that steno-occlusive arterial disease may have on the development of early neurological deterioration (END) in a large series of patients with acute ischemic stroke.


METHODS
We studied a prospective cohort of 1,093 patients admitted to a single tertiary hospital with presence of neurological symptoms in the first 24 h after stroke onset. END was defined as any increase in the National Institutes of Health Stroke Scale score >or=4 points in the first 72 h. The arterial study assessed the presence of arterial occlusion or significative stenosis in the symptomatic territory. Additionally, age, initial stroke severity, blood pressure, glucose levels, vascular risk factors, lacunar stroke and prior use of antithrombotic treatment were also analyzed in a multivariable analysis.


RESULTS
END was detected in 179 patients (16.3%). Steno-occlusive disease (adjusted OR 3.60), initial blood pressure and abdominal obesity were independently associated with END. Both arterial stenosis (adjusted OR 2.33) or occlusions (adjusted OR 3.65) were associated with END. The higher adjusted OR (5.49) was obtained for steno-occlusive arterial disease in the vertebrobasilar system.


CONCLUSIONS
An early arterial study may provide key data for the selection of patients with higher risk of END after acute ischemic stroke.
Ois
Angel
A
Unitat d'Ictus, Servei de Neurologia, Hospital del Mar, Departament de Medicina, Universitat Central de Barcelona, Barcelona, Spain. 94545@imas.imim.es
Martinez-Rodriguez
Jose E
JE
Munteis
Elvira
E
Gomis
Meritxell
M
Rodríguez-Campello
Ana
A
Jimenez-Conde
Jordi
J
Cuadrado-Godia
Elisa
E
Roquer
Jaume
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000150:complications* / Q000175:diagnosis*; D002545:Brain Ischemia / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D006801:Humans; D020765:Intracranial Arterial Diseases / Q000150:complications* / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D013997:Time Factors