ABSTRACT NUMBER: ESOC2026A1766 PROGRESSIVE LACUNAR SYNDROME AND 12-MONTH STROKE RECURRENCE IN ACUTE ISCHEMIC LACUNAR STROKE: ASSOCIATED FACTORS AND LONG-TERM OUTCOMES

Abstract Background and aims Acute ischemic strokes (AIS) of microangiopathic etiology usually result in mild-to-moderate neurological deficits and favorable short-term outcomes. However, a subset of patients may develop early neurological deterioration, called progressive lacunar syndromes (PLS), or ischemic stroke recurrence (ISR). This study aimed to identify associations of PLS and ISR, and their long-term prognostic relevance. Methods We included consecutive AIS of microangiopathic etiology from a single-center prospective stroke registry. The first outcome was PLS, defined as early (≤24 hours) neurological deterioration (≥2 point NIHSS) or fluctuation (≥4-point rise and drop), or progressive worsening (≥4-point) within one week. The second outcome was 1-year ISR. Multivariable logistic regression models were developed for each outcome. Results Among 843 consecutive lacunar strokes (median age 71, IQR 62-81, 43% female), 74 (8.8%) developed PLS. Among 661 patients with 12-month follow-up, 36 (5.4%) experienced ISR. Only two patients had both PLS and ISR. Higher admission NIHSS (adjusted-OR=1.09, 95%CI=0.99–1.8) and diabetes (aOR=2.69, 95%CI=1.55-5.69) were independently associated with PLS, while no acute variable predicted ISR. PLS was independently associated with more unfavorable modified-Rankin-scale-shift (mRS) at 3 (acOR=4.47, 95%CI=2.56-7.79) and 12 months (acOR=2.97, 95%CI=1.55-5.69). ISR was independently associated with worse 12-month mRS (acOR=2.47, 95%CI=1.18-5.15). Conclusions In acute lacunar stroke, PLS is associated with greater baseline stroke severity and diabetes mellitus. Despite a similar association with worse long-term outcome for both outcomes, distinct mechanisms likely underlie PLS and ISR. Conflict of interest George Kurian: nothing to disclose, Patrik Michel: nothing to disclose, Davide Strambo: nothing to disclose