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| Home > Publications database > Risk factors associated with progressive lacunar strokes and benefit from dual anti-platelet therapy. |
| Journal Article | DKFZ-2020-00287 |
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2020
Blackwell Science65503
Oxford
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Please use a persistent id in citations: doi:10.1111/ene.14159
Abstract: Early neurological deterioration (END) occurs in 20-30% of patients with lacunar stroke and challenges their clinical management. This retrospective cohort study analyzed clinical and neuroimaging risk factors predicting the occurrence of END, the functional outcome after END and potential benefit from dual anti-platelet therapy (DAPT) in patients with lacunar strokes.Factors associated with END and benefit from DAPT were retrospectively analyzed in 308 patients with lacunar stroke symptoms and detected lacunar infarction by MRI. END was defined by deterioration of ≥3 total NIHSS points, ≥2 NIHSS points for limb paresis or documented deterioration within five days after admission. Patients were treated with DAPT according to in-house standards. Primary efficacy endpoint for functional outcome was fulfilled if NIHSS at discharge improved after END at least to the score at admission.Male gender (OR=2.08; 95%CI 1.09-4.00), higher age (OR=1.65 per 10 years; 95%CI 1.18-2.31), motor paresis (OR=18.89, 95%CI 4.66-76.57) and infarction of the internal capsule or basal ganglia (OR=3.58, 95%CI 1.26-10.14) were associated with an increased risk for END. Larger diameter of infarction (OR=0.85, 95%CI 0.76-0.95), more microangiopathic lesions (OR=0.75, 95%CI 0.57-0.99) and pontine localization (OR=0.29, 95%CI 0.12-0.65) were factors associated with unfavorable functional outcome after END occurred. Localization in the internal capsule or basal ganglia was identified as significant predictive factor for a benefit from DAPT after END.Identified clinical and neuroimaging factors predicting END occurrence, functional outcome after END and potential benefit from DAPT might improve the clinical management of patients with lacunar strokes.
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