Cardiac sources of embolism in patients with pial artery infarcts and lacunar lesions.

Mast, H.; Thompson, John L.P.; Völler, Heinz; Mohr, J. P.; Marx, Peter

doi:10.1161/01.str.25.4.776

Cited by 28 publications

(17 citation statements)

References 29 publications

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“…Major CSE are reported to occur more frequently in nonlacunar strokes than in lacunar ones [25]but few data are available regarding the prevalence of minor CSE with respect to stroke subtypes [16, 17]. Atrial septal abnormalities – i.e.…”

Section: Discussionmentioning

confidence: 99%

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Transoesophageal Echocardiography in Patients without Arterial and Major Cardiac Sources of Embolism: Difference between Stroke Subtypes

Cerrato¹,

Imperiale²,

Priano

et al. 2002

Cerebrovasc Dis

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We studied the records of 175 consecutive patients referred to our neurologic ward between January 1994 and February 2000 with a diagnosis of ischaemic cerebrovascular disease (ICVD) (stroke or transient ischaemic attack – TIA) who underwent transoesophageal echocardiography (TEE). We excluded patients with large vessel disease, high-risk embolic cardiopathies and other rare causes of stroke. According to clinical and neuroimaging findings, patients were divided into two groups. The lacunar (LAC) group (69/175 (39.4%)) and the nonlacunar (N-LAC) one (106/175 (60.6%)). The control population consisted of 78 consecutive patients, referred to the echocardiography laboratory for TEE without history of ICVD and known heart disorders. Patent foramen ovale (PFO) frequency was significantly higher in case patients than in control subjects (55/175 (31.4%) vs. 13/78 (16.6%); p = 0.02). Among case patients, PFO was more prevalent in the N-LAC group than in the LAC one (43/106 (40.6%) vs. 12/69 (17.4%); p = 0.0005). A large degree of shunt occurred in 53.5% of N-LAC patients and in 16.7% of LAC ones (p = 0.04). Atrial septal aneurysm (ASA) was detected in 12% of case patients and 1.3% of control subjects (p = 0.003) and was more frequent in the N-LAC group than in the LAC one (16 vs. 5.8%; p = 0.05). Mitral prolapse (MP) was present in 6/175 (3.4%) ICVD patients (vs. 1/78 among controls) in most cases associated with myxomatous valve redundancy. Aortic arch atheromas (AA) were detected in 12% of ICVD patients and in 10.2% of controls. The frequency was 9.4% in N-LAC and 15.9 in LAC. No complicated AA (plaque thickness >4 mm, ulcerated atheroma, superimposed thrombus) were detected. After multivariate analysis, PFO (OR = 3.8; 95% CI = 2.7–7.9) and ASA (OR = 8.01; 95% CI = 3.0–16.1) appeared to be independent predictors of ICVD. PFO (OR = 2.24; 95% CI = 1.24–4.92) was also independently associated with N-LAC stroke subtype and its importance was even higher in younger patients. Our study provides further evidence that TEE is a helpful diagnostic tool in stroke patients without arterial and major cardiac sources of embolism. However, its utility differs according to type and localization of the ischaemic lesion being more relevant in patient with N-LAC infarctions.

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Section: Discussionmentioning

confidence: 99%

“…Few authors have investigated the occurrence of minor CSE in the various stroke subtypes [16, 17]as well as the relationship between neuroimaging patterns and TEE findings in patients in which major arterial and CSE have been ruled out [18]. …”

Section: Introductionmentioning

confidence: 99%

Transoesophageal Echocardiography in Patients without Arterial and Major Cardiac Sources of Embolism: Difference between Stroke Subtypes

Cerrato¹,

Imperiale²,

Priano

et al. 2002

Cerebrovasc Dis

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“…Clinically significant extracranial atherosclerosis or major cardioembolic sources were present in some patients with lacunar infarction, but approximately 2 to 3 times less frequently than among patients with cortical infarctions. [41][42][43] Nevertheless, demonstration of an embolic source per se is not sufficient to establish a causal relationship between a clinical lacunar syndrome and a particular cardiac or arterial abnormality.…”

Section: Discussionmentioning

confidence: 99%

Diffusion-Weighted Imaging Identifies a Subset of Lacunar Infarction Associated With Embolic Source

Oliveira‐Filho

Buonanno

et al. 1999

Stroke

156

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Background and Purpose-Small infarcts in the territory of penetrator arteries were described as causing a number of distinct clinical syndromes. The vascular pathophysiology underlying such infarcts is difficult to ascertain without careful pathological study. However, the occurrence of multiple, small infarcts, linked closely in time but dispersed widely in the brain, raises the possibility of an embolic mechanism. The current study determines the frequency and clinical characteristics of patients with well-defined lacunar syndromes and the diffusion-weighted imaging (DWI) evidence of multiple acute lesions. Methods-Sixty-two consecutive patients who presented to the emergency room with a clinically well-defined lacunar syndrome were studied by DWI within the first 3 days of admission. Results-DWI showed multiple regions of increased signal intensity in 10 patients (16%). A hemispheric or brain stem lesion in a penetrator territory that accounted for the clinical syndrome ("index lesion") was found in all. DWI-hyperintense lesions other than the index lesion ("subsidiary infarctions") were punctate and lay within leptomeningeal artery territories in the majority. As opposed to patients with a single lacunar infarction, patients with a subsidiary infarction more frequently (PϽ0.05) harbored an identifiable cause of stroke. Conclusions-Almost

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“…20 For the present study the 483 consecutive cases with complete Doppler ultrasound studies were analyzed: 101 (21%) showing unilateral or bilateral carotid stenosis of 60% or more (including occlusion) and, serving as a reference group, 382 (79%) revealing no pathological findings (nϭ303) or flow changes indicating only a lesser degree of stenosis (nϭ79). The degree of carotid stenosis was assessed by conventional Doppler ultrasound investigations (4-and 8-MHz probe studies, EME TC 2000 machine) of the extracranial neck vessels, following generally accepted definitions, 18,21,22 validated against gold-standard conventional angiography.…”

Section: Methodsmentioning

confidence: 99%

Cigarette Smoking as a Determinant of High-Grade Carotid Artery Stenosis in Hispanic, Black, and White Patients With Stroke or Transient Ischemic Attack

Mast

Thompson

Lin

et al. 1998

Stroke

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Background and Purpose-We sought to investigate the association of cigarette smoking with high-grade carotid artery stenosis in Hispanic, black, and white patients with cerebral ischemia in two independent samples. Methods-Prospectively collected data from the Northern Manhattan Stroke Study (NOMASS) (nϭ431) and the Berlin Cerebral Ischemia Databank (BCID) (nϭ483) were used separately for a cross-sectional study estimating the association between cigarette smoking and high-grade carotid stenosis (defined as a luminal narrowing of Ն60%, diagnosed by duplex and/or Doppler ultrasound). In both studies, cerebral ischemia patients with normal sonographic findings or nonstenosing plaques of their carotid arteries served as a comparison group. Multivariate logistic regression models were used for statistical tests to determine the association between smoking and the dependent variable for high-grade carotid stenosis. Age, sex, hypertension, diabetes, hypercholesterolemia, and race/ethnicity were considered potential confounders. Further analyses of the NOMASS data estimated the effect of the amount of cigarette use and the impact of race/ethnicity. Results-High-grade carotid stenoses were found in 14% of the NOMASS and in 21% of the Berlin patients. In Berlin the entire sample was white, whereas in New York only 19% of the cohort were white. In both samples, smoking was independently associated with severe carotid stenosis (NOMASS: odds ratio [OR], 1.5; 95% confidence interval [CI], 1.1 to 2.0; BCID: OR, 3.9; 95% CI, 2.4 to 6.4). Patients smoking 20 pack-years or more showed a significant association (OR, 2.0; 95% CI, 1.1 to 3.9), whereas no significant effect was found for lower amounts of cigarette use. In NOMASS, white smokers displayed a significant (OR, 3.2; 95% CI, 1.1 to 8.9) association with high-grade carotid stenosis, the association for black smokers was less strong, and no association was found among Hispanics. Conclusions-Smoking is an independent determinant of severe carotid artery stenosis in patients with focal cerebral ischemia. The association differs by race/ethnicity, with the greatest effect observed among whites. (Stroke. 1998;29:908-912.)

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Cardiac sources of embolism in patients with pial artery infarcts and lacunar lesions.

Cited by 28 publications

References 29 publications

Transoesophageal Echocardiography in Patients without Arterial and Major Cardiac Sources of Embolism: Difference between Stroke Subtypes

Transoesophageal Echocardiography in Patients without Arterial and Major Cardiac Sources of Embolism: Difference between Stroke Subtypes

Diffusion-Weighted Imaging Identifies a Subset of Lacunar Infarction Associated With Embolic Source

Cigarette Smoking as a Determinant of High-Grade Carotid Artery Stenosis in Hispanic, Black, and White Patients With Stroke or Transient Ischemic Attack

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