Short-term functional outcomes and treatment trends for branch atheromatous disease and lacunar infarction: a retrospective cohort study of a nationwide multicenter registry

Gaku Fujiwara; Hideki Oka; Akihiro Fujii

doi:10.15441/ceem.24.220

Original Article

doi: https://doi.org/10.15441/ceem.24.220 [Accepted]

Short-term functional outcomes and treatment trends for branch atheromatous disease and lacunar infarction: a retrospective cohort study of a nationwide multicenter registry

Gaku Fujiwara¹, Hideki Oka¹, Akihiro Fujii²

¹Department of Neurosurgery, Saiseikai Shiga Prefecture Hospital, Imperial Gift Foundation Inc, Ritto, Japan
²Department of Neurology, Saiseikai Shiga Prefecture Hospital, Imperial Gift Foundation Inc, Ritto, Japan

Correspondence Gaku Fujiwara Tel: +81775521221, Email: gfujiwara-tuk@umin.ac.jp

Received: March 19, 2024. Revised: June 13, 2024. Accepted: June 13, 2024. Published online: July 19, 2024.

ABSTRACT

Objective
Branch atheromatous disease (BAD) is a form of ischemic stroke that presents with imaging findings similar to those of lacunar infarction, but has a different pathogenesis and is known to cause progressive paralysis. Due to regional variations, the epidemiology of BAD is not well understood, and its relationship with the functional prognosis remains unclear. Using a comprehensive Japanese stroke database, we investigated its epidemiological characteristics and associations with functional outcomes.
Methods
In this multicenter cohort study, we retrospectively analyzed data from 27 hospitals that contributed to the Saiseikai Stroke Database (2013–2021). We used multivariable logistic regression to calculate adjusted odds ratios (aORs) with 95% confidence intervals (CIs) of BAD compared with lacunar infarction (LI) for functional outcomes at discharge. Ischemic stroke caused by BAD or LI was included, and demographic characteristics and clinical data were evaluated and contrasted between BAD and LI.
Results
Of the 5,966 analyzed patients, 1,549 (25.9%) had BAD and 4,434 (74.1%) had LI. BAD was associated with worse functional outcomes (aOR, 2.77; 95% CI, 2.42–3.17; relative to LI) and extended hospital stays (median 19 days for BAD vs. 13 days for LI). Moreover, aggressive treatment strategies, including the use of argatroban and dual antiplatelet therapy, were more common in BAD patients.
Conclusion
BAD presented worse functional outcomes and longer hospital stays than LI, necessitating treatment plans that take into account its progression and prognosis.

Keywords: Ischemic stroke; Branch atheromatous disease; Lacunar infarction; Functional outcome; Antithrombotic therapy; Epidemiology