# Predictors of infarction and outcomes in capsular warning syndrome: a retrospective observational study

## TL;DR

This study identifies risk factors for cerebral infarction in capsular warning syndrome and finds that tirofiban treatment may improve outcomes.

## Contribution

The study identifies novel predictors of infarction and treatment outcomes in capsular warning syndrome using LASSO and logistic regression.

## Key findings

- Elevated platelet count, NIHSS score, ABCD2 score, intracranial atherosclerosis, and male sex predict infarction in CWS.
- Tirofiban infusion is the only independent predictor of favorable 90-day outcomes in infarcted CWS patients.
- 64% of CWS patients in the study progressed to infarction.

## Abstract

Capsular warning syndrome (CWS), a rare subtype of transient ischemic attack, is associated with a high risk of progression to acute cerebral infarction. However, predictive factors for infarction and determinants of functional outcome remain inadequately defined.

In this retrospective study, we analyzed 89 CWS patients admitted between January 2021 and December 2024. Clinical, laboratory, imaging, and treatment data were collected. Patients were stratified into infarcted and non-infarcted groups based on DWI findings. Infarcted patients were followed for 90 days, with outcomes assessed using the modified Rankin Scale (mRS). LASSO regression was used for variable selection, followed by multivariable logistic regression to identify independent predictors of infarction and favorable 90-day outcomes (mRS 0–2).

Of 89 patients, 57 (64%) experienced infarctions. Independent predictors included elevated platelet count (OR = 1.02, 95% CI: 1.01–1.04, p = 0.002), higher NIHSS score (OR = 1.96, 95% CI: 1.25–3.55, p = 0.011), higher ABCD2 score (OR = 1.86, 95% CI: 1.04–3.60, p = 0.047), intracranial atherosclerosis (OR = 10.5, 95% CI: 1.54–99.0, p = 0.024), and male sex (OR = 5.57, 95% CI: 1.32–27.9, p = 0.024). Among 57 infarcted patients, tirofiban infusion was the only independent predictor of favorable outcome (OR = 0.01, CI: 0.00–0.07, p < 0.001).

In CWS, infarction risk is independently associated with platelet count, clinical severity, vascular pathology, and sex. Tirofiban may improve short-term outcomes in infarcted patients. Prospective multicenter studies are needed to validate these findings.

Risk stratification and therapeutic modeling in capsular warning syndrome.Flowchart depicting the process of analyzing capsular warning syndrome (CWS) patients. It starts with 89 CWS patients, highlighting elevated platelet count, ABCD² score, NIHSS score, atherosclerosis, and male sex as predictors of infarction using LASSO regression. From 57 infarcted patients, outcomes are evaluated for functional recovery. Thirty patients were treated with Tirofiban, and their outcomes are measured by a modified Rankin Scale (mRS) score of two or less after ninety days, with 20 out of 30 achieving this outcome (67%).