Large arterial stenosis is associated with early neurological deterioration of middle cerebral artery infarction

Objective To investigate the correlation of large artery stenosis and early neurological deterioration (END) of middle cerebral artery infarction. Methods The patients with middle cerebral artery infarction were enrolled retrospectively. END was defined as that the National Institutes of Health Stroke Scale (NIHSS) scores increased ≥2 within 72 hours of admission compared with the baseline value. Middle cerebral artery and internal carotid artery were evaluated by using cerebral angiography. The degree of stenosis was divided into 4 grades: non- or mild (<50%), moderate (50-70%), severe (71-99%) stenosis, and occlusion (100%). The clinical risk factors, degree of neurological deficits, size of lesion, and major arterial lesions were compared between the END group and the non-END group. Results A total of 256 patients with middle cerebral artery infarction were enrolled, and END occurred in 70 of them (27.34%). The age (P=0.045), infarct volume (P=0.045), baseline NIHSS score (P=0.007), and major arterial stenosis (P=0.038) of the END positive group were significantly higher or lager than those of the END negative group. Multivariate logistic regression analysis showed that the higher baseline NIHSS score (odds ratio [OR] 1.071, 95% confidence interval [CI] 1.004-1.142; P=0.037), infarction diameter >20 mm (OR 2.077, 95% CI 1.077-3.736; P=0.028), and severe stenosis of the major artery (OR 2.521, 95% CI 1.079-5.886; P=0.033) or occlusion (OR 3.074, 95% CI1.262-7.489; P=0.013) were the independent predictor of END. Conclusions Severe stenosis or occlusion of the major artery may be an independent predictor of END in patients with middle cerebral artery infarction. Key words: Stroke; Brain Ischemia; Disease Progression; Intracranial Arteriosclerosis; Cerebral Angiography; Middle Cerebral Artery; Carotid Stenosis; Risk Factors; Time Factors