To examine the association of iatrogenic brain infarcts with patient outcomes

In this post-hoc analysis, we used multi-variable models to evaluate the association of the presence and number of iatrogenic infarcts on DWI with neurological impairment (National Institutes of Health Stroke Scale[NIHSS]), functional status (modified Rankin Scale[mRS]), cognitive and neuropsychiatric outcomes (30-minute test battery) at 1-4 days and 30-days post-procedure. We also related infarct number to a Z-score-derived composite outcome score using quantile regression.

Among 184 patients (median age 56,IQR:50-64), 124 (67.4%) had post-procedural DWI lesions (median 4,IQR:2-10.5). Nerinetide treatment was associated with fewer iatrogenic infarcts but no overall significant clinical treatment effects. Patients with infarcts had lower Mini-Mental State Exam(MMSE) scores at 2-4 days (median:28 vs 29, adjusted-coefficient[acoef]:-1.11, 95%CI:-1.88 to -0.34,p=0.005). Higher lesion counts were associated with worse day-1 NIHSS (aOR for NIHSS≥1:1.07, 1.02-1.12,p=0.009), day 2-4 mRS (adjusted common odds-ratio[aOR]:1.05,1.01-1.09,p=0.005), and day 2-4 MMSE (acoef:-0.07,-0.13 to -0.003,p=0.040) scores. At 30-days, infarct number remained associated with worse mRS (aOR:1.04,1.01-1.07,p=0.016) and Hopkins Verbal Learning Test(HVLT) delayed-recall scores (acoef:-0.21,-0.39 to -0.03,p=0.020). Higher lesion count was associated with worse composite outcome scores at both 1-4 days and 30-days (30-days acoef:-0.12,-0.21 to -0.03,p=0.008). Among those with infarcts, day-1 NIHSS and day 2-4 mRS correlated with 30-day NIHSS, HVLT, and mRS scores, whilst day 2-4 MMSE correlated with 30-day NIHSS scores (Spearman-Rho:0.47,p=0.001).

Iatrogenic brain infarcts were associated with subtle differences in post-procedural(1-4 days) and 30-day outcomes on different measures in this middle-aged cohort, with earlier dysfunction correlating with later differences.