Neurological progression and clinical outcome of branch atheromatous disease

Abstract

Background and Purpose: Neurological progression is often observed among patients with perforating artery territory stroke. The J-BAD Registry database was analyzed to determine the prevalence of neurological progression and clinical outcomes at discharge among patients with branch atheromatous disease (BAD).
Method: Eight Japanese hospitals registered acute stroke patients admitted within seven days of onset whose infarction areas were restricted to the lateral lenticulostriate artery (LSA) territory or paramedian pontine artery (PPA) territory; 413 patients were registered. BAD was defined as an infarction more than 20 mm long along the LSA or a characteristic pontine infarction shape extending to the ventral surface, with neither atrial fibrillation nor more than 50% stenosis of the large artery.
Results: Of the 305 patients with LSA infarctions and the 108 patients with PPA infarctions, 133 (43.6%) and 55 (50.9%), respectively, were classified as having BAD. Neurological progression (a worsening of more than one NIHSS score despite treatment during admission) was found in 30.1 and 15.7% of the LSA patients with and without BAD and 43.6 and 9.4% of the PPA patients with and without BAD. A good clinical outcome at discharge (modified Rankin Scale score of 0 or 1) was observed in 40.5 and 60.0% of the LSA patients with and without BAD and 36.5 and 67.6% of the PPA patients with and without BAD.
Conclusion: The prevalence of BAD was about half of all cases with localized LSA or PPA infarctions. BAD was characterized by neurological progression and a worse clinical outcome at discharge.