Stroke Center and Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea,
Stroke Center and Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea.
Cerebrovasc Dis. 2022;51(5):594-599. doi: 10.1159/000522142. Epub 2022 Mar 3.
Early neurological deterioration (END) occurs in patients with pontine infarction that is adversely associated with a long-term functional outcome. As basilar artery (BA) tortuosity may alter hemodynamics, we investigated whether factors including BA tortuosity are associated with END and poor outcome at 3 months.
We reviewed patients with acute (<7 days from stroke onset) unilateral pontine infarction mainly involving the pontine base and/or tegmental regions from January 2017 through April 2021. END was defined as increase of ≥2 in total National Institutes of Health Stroke Scale (NIHSS) score or ≥1 in motor NIHSS score within first 72 h. A poor clinical outcome was defined as modified Rankin Scale (mRS) 3-6 at 3 months. The BA tortuosity index (TI) was measured: ([actual/straight length -1] x 100). To assess interobserver agreement, TI measurements were obtained by 2 independent raters.
The study included 245 patients; END occurred in 72 (29.3%) and 35 (14.2%) showed poor outcome at 3 months. Old age (odds ratio [OR] = 1.03, 95% confidence interval [CI] 1.004-1.062; p = 0.027), previous stroke history (OR = 2.36, 95% CI: 1.176-4.717; p = 0.016), lower initial NIHSS (OR = 0.72, 95% CI: 0.628-0.827; p < 0.001), and high BA TI (OR = 1.17, 95% CI: 1.062-1.295; p = 0.002) were associated with END. On the other hand, old age (OR = 1.04, 95% CI: 1.002-1.073; p = 0.037) and END (OR = 3.03, 95% CI: 1.429-6.403; p = 0.004) were associated with poor outcome at 3 months.
High BA tortuosity may be a factor associated with END in patients with pontine infarction. As END was related to unfavorable clinical outcome, this risk may have to be carefully considered in patients with high BA tortuosity.
早期神经功能恶化（END）发生在脑桥梗死患者中，与长期功能结局不良有关。由于基底动脉（BA）迂曲可能改变血液动力学，我们研究了包括 BA 迂曲在内的因素是否与 END 和 3 个月时的不良预后相关。
我们回顾了 2017 年 1 月至 2021 年 4 月期间急性（发病后<7 天）单侧脑桥梗死患者的病例，主要累及脑桥基底和/或被盖区。END 定义为 72 小时内 NIHSS 总分增加≥2 分或运动 NIHSS 评分增加≥1 分。3 个月时改良 Rankin 量表（mRS）评分 3-6 定义为预后不良。BA 迂曲指数（TI）测量：[实际/直线长度-1]×100。为评估观察者间的一致性，由 2 名独立的评分者进行 TI 测量。
研究共纳入 245 例患者，72 例（29.3%）发生 END，35 例（14.2%）3 个月时预后不良。高龄（比值比[OR] = 1.03，95%置信区间[CI] 1.004-1.062；p = 0.027）、既往卒中史（OR = 2.36，95%CI：1.176-4.717；p = 0.016）、较低的初始 NIHSS（OR = 0.72，95%CI：0.628-0.827；p < 0.001）和较高的 BA TI（OR = 1.17，95%CI：1.062-1.295；p = 0.002）与 END 相关。另一方面，高龄（OR = 1.04，95%CI：1.002-1.073；p = 0.037）和 END（OR = 3.03，95%CI：1.429-6.403；p = 0.004）与 3 个月时的预后不良相关。
BA 迂曲度高可能是脑桥梗死患者 END 的相关因素。由于 END 与不良临床结局相关，因此在 BA 迂曲度高的患者中，可能需要仔细考虑这种风险。
