Vascular Lesion Thickness in the Lenticulostriate Artery Region Serves as a Biomarker for Early Neurological Deterioration

Background: Early neurological deterioration (END) was common in single small subcortical infarction (SSSI). Distal type of SSSI (dSSSI) was reported to have a lower risk of END than proximal type of SSSI (pSSSI) in lenticulostriate artery(LSA) territory. However, dSSSIs with different lesion thickness might have different risks of END. Objective: In this prospective cohort study, we aimed to investigate whether dSSSIs visible on ≥3 serial axial diffusion weighted imaging (DWI) slices were also imaging markers for END. Methods: Patients of SSSIs in the LSA territory admitted within 72 hours from the onset were selected in a prospective stroke database. Clinical characteristics including the occurrence of END after admission were recorded. The lowest slice (LS), total number of slices (TNS) involved and the maximum axial diameter were evaluated for lesion location and size on axial plane of DWI images. Lesion patterns were categorized according to LS and TNS. Multivariate logistic analysis was performed to determine the imaging pattern that associated with END. Results: A total of 201 out of 1,158 patients were analyzed. END occurred in 32(15.9%) patients after admission. SSSI was categorized to pSSSI (LS≤2), distal and large SSSI (dl-SSSI, LS>2, TNS≥3), distal and small SSSI (ds-SSSI, LS>2, TNS<3) respectively. Multivariate logistic analysis showed that ds-SSSI patients had a significantly lower rate of END(OR 0.20, 95% CI 0.06-0.71, P=0.013) comparing to dl-SSSI patients; pSSSI patients, however, had a similar rate of END (OR 1.27, 95% CI 0.50-3.21, P=0.611) to dl-SSSI patients. Conclusion: Except for pSSSI, dl-SSSI was also an imaging marker for END in the territory of LSA.