Abstract TP96: Mild Luminal Stenosis Of Parent Artery And Neurologic Deterioration After Acute Lacunar Stroke

Introduction:Neurologic deterioration (ND) occurs in a quarter of acute lacunar infarcts and may lead to severe disability, but underlying pathophysiology of ND remains poorly understood. We sought to identify risk factors and clinical characteristics associated with ND.Methods:This retrospective observational study included consecutive patients with acute lacunar stroke admitted to New York University Langone Health and Brown University (NYU/Brown). Lacunar stroke was defined as a subcortical infarct <1.5 cm on CT or <2 cm on diffusion-weighted imaging without significant stenosis (>50%) in the parent vessel and no cardioembolic source. We defined ND as any neurologic deterioration referable to the lacunar stroke and not related to a medical or non-cerebrovascular neurological complication. We used logistic regression analyses to determine associations between ND and luminal stenosis (<50%) vs no luminal stenosis, after adjustment for key confounders. Furthermore, we attempted to validate findings using the Columbia University (CU) stroke registry and perform a meta-analysis combining the derivation and validation groups due to expected small samples and event rates.Results:The NYU/Brown sample included 205 patients, of whom 41 (20%) had ND. In adjusted models, we found no definite association between luminal stenosis and ND (aOR 1.74, 95% CI 0.73-4.14). From CU, 361 total patients were included, of whom 59 (16%) had ND. In adjusted models, we found an association between luminal stenosis and ND (aOR 2.28 95% CI 1.15-4.50). Meta-analysis of both cohorts found luminal stenosis associated with ND (RR [95% CI]: 1.75 [1.23-2.49]).Conclusions:In this multi-center study, luminal stenosis (<50%) may be associated with ND following an acute lacunar infarct. Larger studies using high-resolution vascular imaging modalities such as vessel wall imaging are needed to validate our findings.