The impact of asymptomatic intracranial atherosclerotic stenosis on the clinical outcomes of patients with single subcortical infarction.

Background: The presence of parental arterial disease (PAD) is correlated with the outcomes of patients with a single subcortical infarction (SSI). Due to the relatively low incidence of PAD, the predictors of outcomes seem to be limited for SSI patients without PAD. This study aims to investigate the association between asymptomatic intracranial atherosclerotic stenosis (aIAS) and outcomes in patients with SSI and in the subgroup without PAD. Methods: Patients with SSI were consecutively enrolled. aIAS referred to a stenosis of ≥50% in intracranial arteries irrelevant to SSI by using magnetic resonance angiography. A poor outcome refers to a modified Ranking Scale >2 points at discharge. Results: In total, 298 participants were enrolled. The presence of aIAS could predict a poor outcome for all SSI patients [adjusted relative risk (aRR) = 2.14, 95% confidence interval (CI) = 1.17-3.93, p = 0.014] and in the subgroup without PAD (aRR = 3.12, 95% CI = 1.47-6.62, p = 0.003), but not in the subgroup with PAD. Compared with participants with neither aIAS nor PAD, the risk of a poor outcome increased approximately 2-fold in those with aIAS only (aRR = 2.95, 95% CI = 1.55-5.60, p = 0.001) and in those with concomitant aIAS and PAD (aRR = 3.10, 95% CI = 1.62-5.95, p = 0.001). Conclusion: The presence of aIAS is a predictor of a poor outcome in SSI patients, especially in those without PAD.

Poststroke neutrophil count is predictive of the outcomes of large-artery atherosclerotic stroke and associated with craniocervical atherosclerosis.

Elevation of the neutrophil count is detrimental to the outcome of patients with stroke. The effect of poststroke neutrophil count on the outcome of patients with large-artery atherosclerosis (LAA) stroke is unclear. This study aims to explore the relationship of poststroke neutrophil count with the functional outcome of patients with LAA stroke, and the relationship of poststroke neutrophil count and craniocervical atherosclerotic stenosis (AS) number in these patients. The AS was defined as ≥ 50% stenosis or occlusion attributed to atherosclerosis on craniocervical large arteries. A total of 297 participants were enrolled in the cohort. In multivariable analyses, neutrophil count [adjusted relative risk (aRR) = 1.23, 95% confidence interval (CI) 1.09-1.40, p = 0.001] was an independent predictor of 90-day poor functional outcome [modified Rankin Scale (mRS) > 2 points]. The neutrophil count was significantly associated with the craniocervical AS number in a multivariable ordinal logistic regression analysis [adjusted odds ratio (aOR) = 1.41, 95% CI 1.16-1.72, p = 0.001]. The poststroke neutrophil count is a valuable predictor of 90-day poor functional outcome of patients with LAA stroke. The poststroke neutrophil count is positively correlated with the craniocervical AS number in these patients.

Clinical factors associated with functional outcomes in patients with single subcortical infarction with neurological deterioration.

Objective: Factors that predict poor outcomes in patients with single subcortical infarction (SSI) may differ from those that predict poor outcomes in the SSI subgroup with neurological deterioration (ND). This study aimed to investigate the effect of ND on functional outcomes in patients with SSI and the clinical factors that predict poor outcomes in patients with SSI with ND (SSI-ND) and in all patients with SSI. Methods: Patients with SSI were consecutively enrolled in this study. ND was defined as an increase of ≥2 points in the National Institutes of Health Stroke Scale (NIHSS) total score, an increase of ≥1 point in the NIHSS subscore of consciousness or motor function, or any new neurological deficit. Results: A total of 255 patients were enrolled, and nine (3.53%) were lost to a follow-up. ND [adjusted relative risk (aRR) = 1.37, 95% confidence interval (CI) = 1.22-1.55, p < 0.001], female sex (aRR = 1.13, 95% CI = 1.03-1.24, p = 0.12), initial NIHSS (aRR = 1.08, 95% CI = 1.07-1.10, p < 0.001), and parental arterial disease (PAD) (aRR = 1.16, 95% CI = 1.07-1.26, p = 0.038) were associated with a poor 90-day outcome (the modified Rankin scale (mRS) > 2 points) in patients with SSI. In the SSI-ND subgroup, PAD (aRR = 2.15, 95% CI = 1.20-3.86, p = 0.01), glycosylated hemoglobin (aRR = 1.17, 95% CI = 1.01-1.35, p = 0.035), and severe NIHSS (aRR = 1.15, 95% CI = 1.06-1.25, p = 0.001) were predictive of a poor outcome, and PAD (aRR = 1.87, 95% CI = 1.19-2.95, p = 0.007) was correlated with higher/worsened NIHSS [> 2 points (median)]. For predicting poor outcomes in patients with SSI-ND with PAD, a more severe NIHSS (aRR = 1.09, 95% CI = 1.02-1.17, p = 0.01) was the only determinant, with a cutoff of 4.5 points, a sensitivity of 94.0%, and a specificity of 83.3%. Conclusions: ND is an independent predictor of poor outcomes in patients with SSI, and poor outcome determinants in the SSI-ND subgroup and in all patients with SSI are not identical. For patients with SSI-ND, PAD could aggravate ND and was therefore an essential predictor of poor outcomes.