Background and Purpose: Although the progressing lacunar infarction consists of 12 to 36% of all lacunar infarctions, the clinical predictors and therapeutic methods for progression are not clear. We investigated the role of vascular stiffness in lacunar infarction with motor progression.
Methods: Consecutive 2427 patients over 4 years, who were diagnosed with stroke at the Gachon University Gil Hospital, were reviewed retrospectively. We analyzed lacunar infarction patients in aspect of clinical, laboratory, and pulse wave velocity. Motor progression is defined as one or more increase in the motor score in NIHSS. Good outcome was designated as a modified Rankin scale 0-2 at discharge.
Results: Among all 662 patients who had lacunar infarct, 66 patients experienced motor progression (9.97%). The induced-hypertension therapy group (n=25) received phyenylephrine and conventional group (n=41) received anticoagulation such as heparin, volume expansion, or both. Although there were not significantly different from basline clinical and laboratory findings (ie. age, sex, stroke risk factors, initial BP, and NIHSS), motor progression group showed significantly more frequent BP drop at progression (p<0.0001) and higher pulse wave velocity (p=0.001). Induced-hypertension group (vs. conventional group) had a lower NIHSS (p=0.036) and good outcome at discharge (p=0.004). In multiple regression analysis, pulse wave velocity (odds ratio, OR 1.005, 95% CI 1.001-1.009, p=0.021) was independent predictor for good outcome in the induced-hypertension group. Side effects of phenylephrine treatment was dysuria (n=1).
Conclusions: The present study suggests that vascular stiffness can be not only a predictor for motor progression but also a predictor for motor improvement after induced-hypertension therapy using phenylephrine in lacunar stroke.