title: Analysis of Factors Associated with Progression and Long-Term Outcomes of Penetrating Artery Territory Infarction: A Retrospective Study.
abstract: BACKGROUND
  Patients with penetrating artery territory infarction occasionally show progressive motor deficits during the acute stage with poor prognosis. Predictive indices or medical therapies for suppressing the symptomatic progression (SP) of penetrating artery infarction have not been established. In this study, we investigated SP-related clinical factors and functional outcomes, specifically improvement 3 months post ictus in patients with penetrating artery infarction.
  
  
  METHODS
  We retrospectively examined acute stroke patients with penetrating artery infarction admitted at 7 collaborative hospitals. SP was defined as an increase by 1 point or higher in the National Institutes of Health Stroke Scale score. Functional improvement was assessed based on the modified Rankin Scale at 3 months. The influence of factors, such as patient characteristics, clinical data, medical treatment during the acute stage and on SP, and functional improvement was statistically analyzed.
  
  
  RESULTS
  Four hundred eighty-eight patients (310 men; mean age, 70 years) were examined. Sixty-eight patients (14%) exhibited SP. Multivariate logistic regression analysis revealed that higher hemoglobin A1c (odds ratio [OR], 1.30; 95% confidence interval [CI], 1.10-1.55), body mass index (BMI; OR, .85; 95% CI, .77-.94), and systolic blood pressure on admission (OR, 1.63; 95% CI, 1.19-2.25) were independent predictors of SP in penetrating artery infarction. Dual antiplatelet therapy (DAPT; OR, 3.48; 95% CI, 1.52-8.38) independently influenced functional improvement.
  
  
  CONCLUSIONS
  Initial high blood pressure, diabetes, and low BMI on admission were associated with early progression of penetrating artery infarction. DAPT during the acute stage may contribute to functional improvement.
authors.affiliation: Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan. Electronic address: takemari@neurol.med.osaka-u.ac.jp.
authors.forename: Mariko
authors.initials: M
authors.lastname: Takeuchi
authors.affiliation: Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Kotaro
authors.initials: K
authors.lastname: Miyashita
authors.affiliation: Department of Neurosurgery and Stroke Center, Nakamura Memorial Hospital, Sapporo, Japan.
authors.forename: Jyoji
authors.initials: J
authors.lastname: Nakagawara
authors.affiliation: Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Toyoda
authors.affiliation: Department of Neurology, Stroke Center, Kobe City General Hospital, Kobe, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Todo
authors.affiliation: Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan.
authors.forename: Norifumi
authors.initials: N
authors.lastname: Metoki
authors.affiliation: Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Rieko
authors.initials: R
authors.lastname: Suzuki
authors.affiliation: Department of Neurology, National Hospital Organization Okayama Medical Center, Okayama, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Manabe
authors.affiliation: Department of Neurology, Niigata University Medical and Dental Hospital, Niigata, Japan.
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Akaiwa
authors.affiliation: Department of Neurology, Kyoto Second Red Cross Hospital, Kyoto, Japan.
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Yamamoto
authors.affiliation: Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Nagatsuka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020520:Brain Infarction / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy*; D002097:C-Reactive Protein / Q000378:metabolism; D018450:Disease Progression; D005260:Female; D006400:Hematocrit; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D059409:Stroke, Lacunar / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D002097:C-Reactive Protein
keywords: Penetrating artery territory infarction; body mass index; dual antiplatelet therapy; symptomatic progression