Natural History and Factors Influencing 90‐Day Clinical Outcomes and 1‐Year Recurrence of Thalamic Stroke
Huang Qiang, Cui Ying, Zhang YongboABSTRACT
Objective
To investigate the natural course of cerebral small vessel disease (CSVD) manifested as pure thalamic infarction (PTI) and identify predictors of 90‐day clinical prognosis and 1‐year recurrent major adverse cardiovascular/cerebrovascular events (MACE).
Methods
This retrospective cohort study analyzed 251 consecutive thalamic infarction patients admitted between January 2016 and May 2024. Participants were classified into PTI ( n = 187) or combined‐type thalamic infarction (CTI, n = 64). Primary endpoints included poor 90‐day clinical prognosis (modified Rankin Scale [mRS] ≥ 2) and 1‐year MACE (composite of stroke, acute myocardial infarction, and cardiovascular death). Intergroup comparisons utilized Pearson Chi‐square or Mann–Whitney U tests, with variables showing p ≤ 0.10 in univariate analysis entered into multivariate logistic regression models.
Results
Compared with CTI, PTI patients demonstrated lower baseline National Institutes of Health Stroke Scale (NIHSS) scores (median 1 vs. 3, p < 0.001) and reduced prevalence of atrial fibrillation (2.7% vs. 12.5%), intracranial artery stenosis (ICAS; 48.1% vs. 76.6%), and early neurological deterioration (24.6% vs. 56.3%; all p < 0.05). The 90‐day poor prognosis rate was significantly lower in PTI (4.8% vs. 20.3%, p < 0.001), whereas 1‐year MACE rates did not differ between groups (12.3% vs. 15.6%, p = 0.497). Among PTI cases, territorial distributions comprised inferolateral (80.2%), tuberothalamic (13.4%), paramedian (including Percheron artery, 5.9%), and posterior choroidal arteries (0.5%). Tuberothalamic artery infarctions exhibited higher cognitive impairment rates (36.0%) than other subgroups. Multivariate analysis identified baseline NIHSS as an independent predictor of 90‐day poor prognosis (OR = 1.634, 95% CI 1.152–2.320, p = 0.006), while ICAS was associated with 1‐year MACE (OR = 3.908; 95% CI, 1.188–12.849; p = 0.025) in PTI patients.
Conclusion
PTI presented favorable short‐term outcomes, consistent with initial stroke severity, yet carried a 12.3% annual MACE risk, particularly in patients with coexisting ICAS. These findings underscore the importance of addressing intracranial stenosis in secondary prevention strategies for CSVD.