Abstract TP147: How Different Vascular Pathologies Of Penetrating Artery Disease And Large Parent Arterial Disease Are Associated With Progressive Motor Deficits.
Background and Purpose: Penetrating artery infarcts (PAI) are caused by two different vascular pathologies those include atheromatous occlusion at the orifice of large caliber penetrating arteries termed branch atheromatous disease (BAD) and lipohyalinotic degenerative changes termed lipohyalinotic degeneration (LD). PAI are sometimes accompanied by underlying large parent arterial disease (LPAD). We investigated the relationship between 2 different atheromatous lesions, BAD and LPAD, and how 2 lesions may associate with progressive motor deficits (PMD).
Subjects and methods: We studied consecutive 568 patients with acute PAI in the territories of the lenticulostriate artery (LSA) (n=373) or paramedian pontine arteries (PPA) (n=195). The LPAD was defined as middle cerebral artery atherosclerosis responsible for LSA infarct or basilar artery atherosclerosis for PPA infarct evaluated by MRA. BAD of the LSA was defined as infarcts visible for 3 or more axial slices at a slice thickness of 7 mm and that of the APA was unilateral infarcts extending to the basal surface of the pons. Other type than BAD were categorized as LD. Finally, patients were classified into 4 groups: G1. LD type infarct in the territory of LSA (n=208), G2. BAD type in the LSA (n=164), G3. LD type in the PPA (n=69), G4. BAD type in the PPA (n=122). PMD was defined as worsening by ≥1 point in the motor item of the NIHSS.
Results: The prevalence of LPAD in 4 groups was as follows: G1; 12 (5.7%), G2; 48 (29.2), G3; 14 (20.2), G4; 68 (55.7). PMD in 4 groups was as follows: G1; 25 (12.0%), G2; 78 (47.5), G3; 8 (11.5), G4; 42 (34.4). Logistic regression analysis was performed estimating G1 as reference to calculate the odds ratio of each group for PMD. Univariate analysis: G2; 6.7 (P<0.0001), G3; 0.91 (0.86), G4; 5.5 (P<0.0001). The odds ratio of LPAD for PMD are 2.9 (0.0002) in LSA group and 1.4 (0.25) in PPA group. Multivariate analysis: odds ratio of G2 and LPAD for PMD were 6.0 (p<0.0001) and 1.6 (p=0.13) in LSA group, and that of G4 was 6.1 (p=0.0006).
Conclusion: BAD and LPAD were strongly associated each other. Although BAD were significantly correlated with PMD in both territories of LSA and PPA, LPAD was not significantly associated with PMD. BAD, rather than LPAD, appears to be more crucial for PMD in acute PAI patients.
- © 2012 by American Heart Association, Inc.