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Clinical and Prognostic Characteristics of Acute BAD-Related Stroke: A Multicenter MRI-Based Prospective Study
Shengde Li1, Lihua Wang2, Bin Liu3
1Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (S. Li, L.Z., Y.Z., J.N., B.P.).
Background:
Branch atheromatous disease (BAD)-related stroke has emerged as a meaningful subtype of ischemic stroke yet remained understudied. We aimed to investigate the demographic, clinical, therapeutic, and prognostic characteristics of BAD-related stroke.
Methods:
The BAD-study was a nationwide, multicenter, prospective, observational cohort study in 20 Chinese hospitals from June 2021 to June 2023, enrolling patients aged 18 to 80 years with BAD-related stroke within 72 hours of onset. Eligible single subcortical infarct in the territory of lenticulostriate artery and paramedian pontine artery was included. Clinical, laboratory, and treatment data were collected at baseline. The primary outcome was a proportion of good outcomes (modified Rankin Scale score, 0-2) at 90 days. Main secondary outcomes included early neurological deterioration (END), cerebrovascular event, major bleeding, and excellent outcome (modified Rankin Scale score, 0-1) during 90-day follow-up.
Results:
We finally enrolled 476 patients, with a median age of 60 (interquartile range, 53-68) years, and 70.2% were male. The median National Institutes of Health Stroke Scale score was 3 (interquartile range, 2-6) at enrollment. Involvement of the lenticulostriate artery was more common than the paramedian pontine artery (60.7% versus 39.3%). END occurred in 14.7% of patients, with a median time from onset of 38 (interquartile range, 22-62) hours. The rates of good and excellent outcomes were 86.5% and 72%, respectively. Its 90-day stroke recurrence rate was 1.9%. Acute-phase therapy (from onset to 7 days of enrollment) showed heterogeneity and was not associated with prognosis. Multivariable logistic regression analysis identified the National Institutes of Health Stroke Scale score ≥4 at admission and END as negative predictors and extracranial artery stenosis as a positive predictor of good outcomes. Age ≥60 years, National Institutes of Health Stroke Scale score ≥4 at admission, and END were negative predictors of excellent outcomes.
Conclusions:
With distinct demographic, clinical, and prognostic characteristics, along with a high incidence of END and a low risk of stroke recurrence, BAD-related stroke could be categorized as a separate disease entity. Moreover, its acute-phase treatment strategies were undetermined, awaiting further high-quality studies.
Insights
Branch atheromatous disease (BAD)-related stroke, a distinct ischemic stroke subtype, shows unique characteristics. This study highlights its specific demographics, clinical features, and prognostic factors, including a high rate of early neurological deterioration.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Epidemiology
Background:
- Branch atheromatous disease (BAD)-related stroke is an understudied ischemic stroke subtype.
- Understanding its characteristics is crucial for targeted interventions and improved patient outcomes.
Purpose of the Study:
- To investigate the demographic, clinical, therapeutic, and prognostic features of BAD-related stroke.
- To characterize early neurological deterioration (END) and long-term outcomes in this patient cohort.
Main Methods:
- A nationwide, multicenter, prospective observational cohort study (BAD-study) in China.
- Enrolled 476 patients aged 18-80 with BAD-related stroke within 72 hours of onset.
- Assessed outcomes including good outcome (mRS 0-2), excellent outcome (mRS 0-1), END, and stroke recurrence at 90 days.
Main Results:
- Median age was 60 years, 70.2% male; median NIHSS score was 3.
- Lenticulostriate artery involvement was more common (60.7%) than paramedian pontine artery (39.3%).
- END occurred in 14.7% of patients; good and excellent outcomes were 86.5% and 72%, respectively. Stroke recurrence was 1.9% at 90 days. NIHSS score ≥4 and END predicted poor outcomes, while extracranial artery stenosis predicted good outcomes.
Conclusions:
- BAD-related stroke exhibits distinct demographic, clinical, and prognostic profiles, warranting classification as a separate entity.
- High incidence of END and low recurrence rate observed; acute-phase treatment strategies require further investigation.
