Introduction:
Deep subcortical infarction sometimes presents with progressive neurological deficit (PND). The etiology of PND is the occlusion of perforating arteries due to cerebral small vessel disease. Cerebral small vessel disease is associated with arterial stiffness, a marker of both arteriosclerosis and vascular endothelial impairment, and can cause neurological damage.
Hypothesis:
Arterial stiffness is independently associated with PND in patients with acute deep subcortical infarcts.
Methods:
Between October 2003 and March 2010, 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 seven days of stroke onset. Patients were assessed for risk factors, and infarct size was measured on initial diffusion-weighted magnetic resonance imaging (DWI). We measured brachial-ankle pulse wave velocity (baPWV) as a marker of arterial stiffness using an oscillometric device (Form PWV/ABI®; Omron Colin Co., Ltd., Tokyo, Japan). We divided patients into two 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 without PND. The baPWV cutoff 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 (OR) 8.22, 95% confidence interval (95% CI) 2.55-31.9], large infarct size (≥15 mm, OR 2.76, 95% CI 1.01-7.92) and ≥3 infarct slices on serial axial DWI (OR 3.38, 95% CI 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.
Arterial Stiffness Using Cardio-Ankle Vascular Index Reflects Cerebral Small Vessel Disease in Healthy Young and Middle Aged Subjects
