Clinical Study On Progressive Cerebral Infarction Due To Large-Artery Atherosclerosis

Background:Progressive cerebral infarction is a kind of refractory cerebrovascular disease.Although patients are treated regularly,neurological deficits are aggravated suddenly or gradually during several days or several weeks.There are many clinical studies focusing on progressive cerebral infarction.However,there is still no consensus on the mechanism and risk factors of progression,and few studies have classified its etiology.Objective:To determine the relevant factors contributing to progressive and the relationship between progressive cerebral infarction and the prognosis after following3 months follow-up.we mainly based on the cerebral infarction of the large-artery therosclerosis(LAA),which is more common subtype according to Chinese Ischemic Stroke Subclassification(CISS).Methods:Continuously collected patients with acute LAA,who were hospitalized in our department of neurology between May 2017 and July 2018.The diagnosis of LAA was made based on the CISS classification criteria.All the patients were divided into two groups:progressive group,whose National Institutes of Health Stroke Scale(NIHSS)was increased by 2 or more points within 72 hours of onset,and non-progressive group,whose NIHSS was less than 2 points compared with admission or neurological improvement within 72 hours of onset.All enrolled patients were statistically analyzed for clinical data,laboratory examinations,imaging features,complications,and treatment at admission,as well as followed up for modified Rankin Scale(mRS)by telephone after 3 months of onset.All participants were divided into the poor prognosis group:mRS>2 points(disability/death),and the good prognosis group:mRS?2 points.The continuous variables were measured by Student t test or Mann-Whitney test,the categorical variables used?~2 test or Fisher's exact test,and the variables who were statistically significant in aforementioned analyses were selected further into multivariate logistic stepwise regression model.Statistical significance was defined as P<0.05.Results:1.A total of 351 patients with acute LAA were enrolled,including 112 patients in the progressive group(31.9%)and 239 in the non-progressive group(68.1%).2.Multivariate logistic stepwise regression analysis showed that systolic blood pressure at admission,fibrinogen,watershed cerebral infarction,severe stenosis/occlusion,and pulmonary infection were the related factors of progressive cerebral infarction due to LAA.3.A total of 335 patients(95.4%)completed follow-up.The 3 months follow-up date showed that the incidence of disability/death in the progressive group was 79.2%,which was significantly higher than that in the non-progressive group(20.1%),and the difference was statistically significant(P<0.05).4.Multivariate Logistic stepwise regression analysis showed that the progression and the history of diabetes were the related factors of the poor prognosis at 3 months.Conclusions:1.Increased systolic blood pressure,increased fibrinogen,watershed cerebral infarction,severe stenosis/occlusion of blood vessels and pulmonary infection are related factors of progressive cerebral infarction due to LAA.2.The progression of LAA,the history of diabetes are associated with poor prognosis at 3 months.