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Multiple chronic lacunes predicting early neurological deterioration and long-term functional outcomes according to TOAST classification in acute ischemic stroke

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Abstract

Introduction

Studies regarding multiple chronic lacunes (MCLs) and clinical outcome according to stroke etiology are scarce. We sought to evaluate the association between MCL and short-term/long-term clinical outcomes according to stroke etiology.

Patients and methods

We analyzed a prospectively collected stroke registry of acute ischemic stroke patients over 4 years. The enrolled patients were classified as having large artery atherosclerosis (LAA), small vessel occlusion (SVO), cardioembolic (CE) stroke, and other etiology. The early neurological deterioration (END) and favorable outcome at 3 months were assessed.

Results

A total of 1070 patients were enrolled. Patients with MCL had significantly more END compared to those without MCL both in total population (adjusted odds ratio (OR), 1.7; 95% confidence interval [CI], 1.1–2.5; p = 0.013*) and in the LAA group (adjusted OR, 2.3; 95% CI, 1.3–4.2, p < 0.006). Patients with MCL had a significantly lower OR for favorable outcome at 3 months compared to those without MCL both in total population (adjusted OR, 0.7; 95% CI, 0.5–1.0, p = 0.035) and in the LAA group (adjusted OR, 0.6; 95% CI, 0.3–1.0, p = 0.043). However, MCL was not associated with END or long-term functional outcome in patients with SVO, CE, or other etiology.

Conclusions

The presence of MCL was an independent predictive factor for END as well as long-term poor functional outcome in acute ischemic stroke patients. These associations were only observed in patients with LAA, not in those with SVO, CE, or other etiology.

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Data availability

The de-identified data supporting the findings of this study are available upon reasonable request to the corresponding author.

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Authors and Affiliations

  1. Department of Neurology, College of Medicine, Incheon St. Mary’s Hospital, The Catholic University of Korea, #56 Dongsu-ro, Bupyeong-gu, Incheon, 21431, Seoul, Korea

    Hyuk-je Lee, Taewon Kim, Young-Do Kim, Seunghee Na, Yun Ho Choi, In-Uk Song & Sung-Woo Chung

  2. Department of Neurology, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea

    Jaseong Koo

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  1. Hyuk-je Lee
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Contributions

HL, TK, and JK contributed to the conception and design of the study. YDK, SN, YHC, IU, and SWC contributed to the analysis of the data. HL and TK contributed to drafting the text and preparing the tables and figure.

Corresponding author

Correspondence to Taewon Kim.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional committee and the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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All aspects of this retrospective study were approved by the Institutional Review Board of The Catholic University of Korea (IRB). The requirement for informed consent was formally waived by the IRB due to the retrospective nature of the study.

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Lee, Hj., Kim, T., Koo, J. et al. Multiple chronic lacunes predicting early neurological deterioration and long-term functional outcomes according to TOAST classification in acute ischemic stroke. Neurol Sci 44, 611–619 (2023). https://doi.org/10.1007/s10072-022-06446-5

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