Lipid and hyperglycemia factors in first-ever penetrating artery infarction, a comparison between different subtypes.

BACKGROUND

The pathogenesis and progression of branch atheromatous disease (BAD), which differs from lipohyalinotic degeneration (LD), remains controversial. Few studies have investigated the lipid indices and glycometabolism status factors for BAD in first-ever penetrating artery infarction (PAI).

METHODS

We retrospectively examined acute stroke patients with PAI admitted within 3 days after stroke. All patients underwent diffusion weight magnetic resonance imaging (DWI) and magnetic resonance angiography (MRA) and/or computed tomography angiography (CTA). Progression was defined as an increase by 2 point or higher in the National Institutes of Health Stroke Scale score. The characteristics, clinical data were statistically analyzed.

RESULTS

BAD and LD were diagnosed in 142 (57%) and 107 (43%) patients, respectively. Patients with BAD had higher low-density lipoprotein cholesterol (LDL-C) compared with those with LD (= .013). Elevated LDL-C was related to early neurological deterioration in patients with BAD (= .045). The percentage of lenticulostriate arterial (LSA) infarction was greater than that of the pontine penetrating arterial (PPA) infarction in acute PAI (75.1% vs. 24.9%;  < .001). PPA infarction was more prevalent in the BAD group compared with the LD group (34.5% vs. 12.1%, < .001). The PPA infarction had older age at onset and higher HbA1c concentrations than those with the LSA infarction (= .014, = .036 respectively) in the BAD and LD patients, respectively.

CONCLUSION

LDL-C may be associated with both the pathogenesis and progression of intracranial BAD. The LSA infarction was the most frequently subtypes in PAI. Age at onset and HbA1c seem to be closely associated with the PPA infarction of first-ever PAI.