Abstract 3490: Perfusion Defect Is Associated With Poor Prognosis Of Lacunar Infarction.
Backgrounds: Small subcortical infarctions are caused by lipohyalinosis and also by microatheroma and microembolism. However, it remained still unknown which clinical or radiological findings could be useful for prediction of long-term prognosis. We sought to find whether perfusion images are associated with long-term poor clinical status.
Methods: We reviewed 197 patients who admitted from January, 2009 to January, 2011, and who had the lacunae(≤20mm) in the perforator territory of the middle cerebral artery on diffusion-weight MRI(DWI) within 3 days of onset. T2 weighted imaging and perfusion-weighted MRI(PWI) were evaluated in all participants. We divided the patients according to the existence of perfusion defect and analyzed the association between perfusion defect and poor outcomes, defined as modified Rankin score(mRS)≥3 at 3 months
Results: Among a total 197 patients(69 Men; 63.8±11.2y), 78 subjects(52 Men; 62.4±12.1y) had the perfusion defect on PWI. The subject with perfusion defect had the higher frequency of current smoker(P=0.03) and poor outcomes at 3 months (P=0.002), compared to those without. There was no difference in other risk factors, infarct size or parent artery stenosis between two groups. Multivariate binary regression analysis showed that the perfusion defect was strongly associated with poor outcomes at 3 months(P=0.002;adjusted OR 4.21; adjusted 95% CI,1.73-10.28). The propensity score regression analysis also indicated that perfusion defect could predict the poor prognosis(Propensity score adjusted OR,3.88).
Conclusion: Perfusion defect of small vessel disease seems to have the influence on the recovery after lacunae. Further study may be needed to find whether the PWI can be useful for diagnosing the various etiology of lacunae.
- © 2012 by American Heart Association, Inc.