Background: Patients with intracranial atherosclerosis (ICAS) are at high risk of early recurrence or neurologic deterioration. Although minor stroke and transient ischemic attack (TIA) seem benign, their occurrence in patients with ICAS may lead to early neurological deterioration (END). We aimed to identify factors associated with END in ICAS patients presenting with acute minor stroke or TIA, with a focus on early MRI findings. Methods: This was a retrospective analysis of consecutive patients with acute minor stroke or TIA admitted within 12 h of symptom onset. Patients with moderate-severe stenosis of the middle cerebral artery or basilar artery (BA) were included. All patients underwent MRI, including diffusion-weighted imaging (DWI), and magnetic resonance angiography. DWI lesion patterns were classified as perforating artery infarcts, pial infarcts, territorial infarcts and border zone infarcts (BIs). END was diagnosed as an increase of ≧4 points on the National Institutes of Health Stroke Scale from baseline during the 1st week. Results: Of the 95 patients enrolled in the study, 14 (14.7%) developed END. Independent predictors of END were the presence of BIs on baseline DWI (odds ratio, OR, 7.21; 95% confidential interval, CI, 1.88–27.66; p = 0.004) and BA disease (OR, 4.33; 95% CI, 1.11–16.92; p = 0.035). Conclusions: ICAS patients with BI and BA disease are at high risk of END after minor stroke or TIA. Early radiological findings may be helpful in predicting END and guiding early treatment strategies.

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