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The Impact of Diagnosing Branch Atheromatous Disease for Predicting Prognosis

Taizen Nakase1, Yasumasa Yamamoto2, Makoto Takagi3

  • 1Department of Stroke Science, Research Institute for Brain and Blood Vessels-Akita, Akita, Japan.

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
|August 4, 2015
PubMed

Insights

Branch atheromatous disease (BAD) stroke patients experienced worse outcomes than lacunar infarction (LI) patients. Identifying BAD is crucial for predicting prognosis in penetrating artery infarction.

Area of Science:

  • Neurology
  • Vascular Neurology
  • Stroke Medicine

Background:

  • Previous reports indicated worse outcomes in acute penetrating artery infarction patients with branch atheromatous disease (BAD) compared to lacunar infarction (LI).
  • A prospective multicenter study, the Japan Branch Atheromatous Disease (J-BAD) Registry, was established to investigate the clinical features of BAD.

Purpose of the Study:

  • To prospectively explore the clinical features of branch atheromatous disease (BAD) in patients with penetrating artery infarction.
  • To compare the clinical courses and neuroimaging findings between BAD and lacunar infarction (LI) in specific arterial territories.

Main Methods:

  • Prospective enrollment of acute ischemic stroke patients from 9 hospitals into the J-BAD Registry.
  • Classification of patients into lenticulostriate arterial (LSA) infarction (n=124) and pontine penetrating arterial (PPA) infarction (n=42) groups.
  • Investigation of clinical courses and serial magnetic resonance imaging (MRI) findings.

Main Results:

  • Neurologic worsening was significantly higher in BAD patients compared to LI patients in both LSA (45.1% vs. 22.6%) and PPA (46.7% vs. 0%) groups.
  • Ischemic lesion enlargement was more frequent in BAD patients within the LSA group (66.2% vs. 34.0%).
  • Lesion enlargement significantly correlated with worsening neurologic deficits (P < .001); BAD and older age predicted lesion enlargement.

Conclusions:

  • Lenticulostriate arterial (LSA) infarction in patients with branch atheromatous disease (BAD) or older age may lead to increased lesion size and neurologic worsening.
  • Distinguishing BAD from other ischemic stroke subtypes is important for accurate prognosis prediction.
Abstract

Keywords:
Acute strokeMRIdiagnosisprognosis

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