Advancements in understanding the mechanisms of symptomatic lacunar ischemic stroke: translation of knowledge to prevention strategies

Arboix, Adrià; Blanco-Rojas, Lorena; Martí-Vilalta, J L

doi:10.1586/14737175.2014.884926

Cited by 86 publications

(53 citation statements)

References 143 publications

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“…Our study has some limitations. Although diabetic patients had poorer short-term functional prognosis in our population, previous studies showed that the subgroup of diabetic patients with lacunar infarction shows a better outcome [21,22] . However, magnetic resonance imaging is not available in our institution and imaging of the intra-or extracranial arteries was also not performed in all patients.…”

Section: Discussionmentioning

confidence: 52%

Type 2 diabetes is associated with a worse functional outcome of ischemic stroke

Τζιόμαλος¹,

Spanou²,

Bouziana³

et al. 2014

WJD

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AIM:To assess whether ischemic stroke severity and outcome is more adverse in patients with type 2 diabetes mellitus (T2DM). METHODS:Consecutive patients hospitalized for acute ischemic stroke between September 2010 and June 2013 were studied prospectively (n = 482; 40.2% males, age 78.8 ± 6.7 years). T2DM was defined as self-reported T2DM or antidiabetic treatment. Stroke severity was evaluated with the National Institutes of Health Stroke Scale (NIHSS) score at admission. The outcome was assessed with the modified Rankin scale (mRS) score at discharge and with in-hospital mortality. Adverse outcome was defined as mRS score at discharge ≥ 2 or in-hospital death. The length of hospitalization was also recorded. RESULTS:T2DM was present in 32.2% of the study population. Patients with T2DM had a larger waist circumference, higher serum triglyceride and glucose levels and lower serum high-density lipoprotein cholesterol levels as well as higher prevalence of hypertension, coronary heart disease and congestive heart failure than patients without T2DM. On the other hand, diabetic patients had lower low-density lipoprotein cholesterol levels and reported smaller consumption of alcohol than non-diabetic patients. At admission, the NIHSS score did not differ between patients with and without T2DM (8.7 ± 8.8 and 8.6 ± 9.2, respectively; P = NS). At discharge, the mRS score also did not differ between the two groups (2.7 ± 2.1 and 2.7 ± 2.2 in patients with and without T2DM, respectively; P = NS).Rates of adverse outcome were also similar in patients with and without T2DM (62.3% and 58.5%, respectively; P = NS). However, when we adjusted for the differences between patients with T2DM and those without T2DM in cardiovascular risk factors, T2DM was independently associated with adverse outcome [relative risk (RR) = 2.39; 95%CI: 1.21-4.72, P = 0.012]. Inhospital mortality rates did not differ between patients with T2DM and those without T2DM (9.0% and 9.8%, respectively; P = NS). In multivariate analysis adjusting for the difference in cardiovascular risk factors between the two groups, T2DM was again not associated with in-hospital death.CONCLUSION: T2DM does not appear to affect ischemic stroke severity but is independently associated with a worse functional outcome at discharge.

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Section: Discussionmentioning

confidence: 52%

Type 2 diabetes is associated with a worse functional outcome of ischemic stroke

Τζιόμαλος¹,

Spanou²,

Bouziana³

et al. 2014

WJD

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“…In contrast, studies based on neuroimaging have been definitely more numerous. In a majority of them, BAD-related infarctions were broadly identified as those occurring in the subcortical regions whose blood perfusion depends on deep small penetrating vessels [5,21] . In the anterior circulation, these pertain to lenticulostriate artery terminations stemming from the middle cerebral artery (MCA) and Heubner's artery originating from the anterior cerebral artery [22] .…”

Section: Neuroimaging Featuresmentioning

confidence: 99%

Branch Atheromatous Disease: A Clinically Meaningful, Yet Unproven Concept

Petrone

Nannoni²,

Bene³

et al. 2015

Cerebrovasc Dis

121

125

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Background: In 1989, Louis Caplan first used the term branch atheromatous disease (BAD) to describe an occlusion or stenosis at the origin of a deep penetrating artery of the brain, associated with a microatheroma or a junctional plaque, and leading to an internal capsule or pontine small infarct. BAD remained an understudied concept for decades. In recent years, the increasing diffusion of high-resolution magnetic resonance imaging (HRMRI) techniques brought new attention to the BAD debate. We have reviewed clinical studies dealing with BAD-related stroke checking whether a univocal definition of BAD existed, as well as to what extent were consistently associated clinical and imaging features reported. Summary: We conducted a search of the available literature published up to October 20, 2015 via PubMed using the following search terms: ‘branch atheromatous disease,' ‘intracranial branch atheromatous disease,' ‘cerebral branch atheromatous disease,' combined with ‘stroke.' Forty-six articles were included. We found discrepant definitions and a large variation among clinical features reported in BAD-related stroke patients: among others, a consistent association between BAD and any specific vascular risk factor profile was not detected. Despite this, early neurological deterioration (END) was consistently reported to occur frequently in such patients, although no clear-cut rate range or specific predictor or mechanism of progression was established. In a majority of the studies reporting imaging data, BAD diagnosis was not based on the selective site or type of arterial walls changes, but was inferred based on the vascular territory, size and/or shape of the ischemic lesion. Following the concept that these changes are seated proximally along the perforator artery, differently from to lipohyalinosis changes located distally, the consequent ischemic lesion was hypothesized to be larger in BAD than in lacunar infarcts. However, across reviewed studies, there was little consistency on the dimensional cutoff used to define BAD-related infarcts. In the last few years, a still limited number of studies using HRMRI techniques is providing preliminary proofs that atheromatous changes causing selective remodeling in the parent vessel and extending through the proximal segment of perforating vessel may subtend BAD. Key Messages: Our literature search showed the lack of a clear-cut definition of BAD, although BAD-related strokes were consistently considered a high risk of END. The use of high-resolution imaging techniques in the assessment of small subcortical strokes may represent the cornerstone in the perspective to better delimiting the boundaries of BAD as a nosological entity.

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“…Furthermore, current studies clearly show that neuropsychological dysfunction in the initial phase relates more to silent lacunar infarction than to leukoaraiosis or periventricular white matter hyperintensities [22] . This contrasts with the fact that in more advanced stages of the disease, leukoaraiosis will have the greatest importance and greater weight in cognitive impairment of vascular type in patients with cerebral small vessel disease [19,20] . Recurrent lacunar infarction can also cause cognitive impairment.…”

Section: Lacunesmentioning

confidence: 91%

“…The silent lesions tend to be due to a cerebrovascular lipohyalinosis in the perforating arterioles or arteriolar endothelial dysfunction [18] . We must bear in mind that in patients with a first-ever lacunar infarct, 40% of them shows "lacunes" that are clinically silent [19] .…”

Section: Lacunesmentioning

confidence: 99%

Definitions for Lacunar Syndromes, Lacunar Strokes, Lacunar Infarcts and Lacunes: from Clinical to Neuroimaging

Adri�Arboix¹,

Jos�S醤chez

2015

International Journal of Neurology Research

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A rational use of nomenclature concerning lacunar infarcts is necessary. The term "lacunar syndrome" involves a clinical and semiological aspect; the definition "lacunar stroke" entails a clinical, semiological and neuroimaging aspect; the term "lacunar infarct" implies a particular subtype of ischemic stroke and the definition of "lacune" relates to neuroimaging findings. It would be suitable to use a precise nomenclature when we talk about the cerebral small vessel diseases and, specifically, about cerebral strokes of lacunar type, since this will result in a more accurate, appropriate and wise definition and will improve the quality of studies and investigations.

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Advancements in understanding the mechanisms of symptomatic lacunar ischemic stroke: translation of knowledge to prevention strategies

Cited by 86 publications

References 143 publications

Type 2 diabetes is associated with a worse functional outcome of ischemic stroke

Type 2 diabetes is associated with a worse functional outcome of ischemic stroke

Branch Atheromatous Disease: A Clinically Meaningful, Yet Unproven Concept

Definitions for Lacunar Syndromes, Lacunar Strokes, Lacunar Infarcts and Lacunes: from Clinical to Neuroimaging

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