Factors influencing the early neurological deterioration in intracranial branch atheromatous diseases

Abstract Background Intracranial branch atheromatous disease (BAD)‐type cerebral infarction is often associated with a progressive worsening of neurological symptoms in the acute phase. Aim To investigate the factors influencing the occurrence of early neurological deterioration (END) in patients with BAD. Methods We included and evaluated 198 consecutive patients (150 patients with lenticulostriate artery LSA‐BAD and 48 patients with paramedian pontine artery PPA‐BAD) with onset within 24 h and with a modified Rankin scale score of ≤1 before admission for END retrospectively out of 235 patients with BAD‐type cerebral infarction admitted to our hospital from January 2019 to March 2023. Results END was observed in 26 (17%) and 15 (31%) patients with LSA‐BAD and PPA‐BAD, respectively. Patients in the END group with LSA‐BAD had significantly higher rates of diabetes mellitus and blood glucose (BG) levels on admission and lower rates of initial clopidogrel loading therapy than those in the non‐END group. Patients in the END group with PPA‐BAD had significantly higher BG levels on admission than those in the non‐END group. In LSA‐BAD multivariate analysis, the BG level on admission and initial clopidogrel loading were identified as factors influencing END (BG level per 10 mg/dL, odds ratio OR 1.084, 95% confidence interval CI 1.008–1.166; initial clopidogrel loading, OR 0.302, 95% CI 0.101–0.901). Conclusions Higher BG levels at stroke onset were associated with END in patients with LSA‐BAD and PPA‐BAD. Additionally, initial clopidogrel loading therapy suppressed END in patients with LSA‐BAD.