Carotid angiography in patients with lacunar infarction. A prospective study.

Background and Purpose-We sought to determine the relations between infarct subtype and white matter hyperintensities (WMHIs) on MRI. Materials and Methods-We studied 395 ischemic stroke patients with 1.0-T MRI. The number of lacunar, border-zone, and cortical infarcts was registered. WMHIs were analyzed in 6 areas. Univariate and multivariate statistical analyses were used to find the risk factors for different infarct subtypes and to study the connections between WMHIs and brain infarcts. Results-Lacunar

Section: Risk Factors and Infarct Subtypesupporting

confidence: 93%

Magnetic Resonance Imaging White Matter Hyperintensities and Mechanism of Ischemic Stroke

Mäntylä¹,

Aronen²,

Salonen³

et al. 1999

“…39 According to the lacunar hypothesis, small-vessel disease (from lipohyalinosis and fibrinoid degeneration) 16 -20 is the most important cause of lacunar infarction, whereas atherosclerosis and embolism are less important. Nevertheless, both cardiac embolism 24 -26,28 and large-artery atherosclerosis 21,22,27,31,32 have been increasingly recognized and described as potential causes of lacunar stroke.…”

Section: Discussionmentioning

confidence: 99%

“…Small-artery disease (from lipohyalinosis and fibrinoid degeneration), 16 -20 large-artery atherosclerosis, [21][22][23] and embolism 24 -28 have been implicated as potential causes of lacunar infarcts. However, some authors consider cardiac and carotid embolism unlikely causes of lacunar infarction.…”

mentioning

confidence: 99%

Carotid Artery Intima-Media Thickness and Lacunar Versus Nonlacunar Infarcts

Cupini

Pasqualetti

Diomedi

et al. 2002

Background and Purpose-Increases in the thickness of the intima and media of the carotid artery have been associated with an increased risk of myocardial infarction and stroke in subjects without a history of cardiovascular disease. Lacunar infarcts, one of the most common subtype of ischemic stroke, show unique pathological and clinicoradiological characteristics. The present study examines the relationship between vascular risk factors, including carotid artery intima-media thickness (IMT), and lacunar versus nonlacunar infarcts. Methods-We collected data from patients with acute ischemic stroke admitted to hospital. Patients and 129 control subjects underwent B-mode ultrasonographic measurements of IMT of the common carotid artery. We examined the association of lacunar and nonlacunar infarcts with age, sex, and potential vascular risk factors. Results-Of 292 adult patients with an acute first-ever ischemic stroke, 96 were considered lacunar and 196 were considered nonlacunar strokes. We did not find a significantly different percentage of diabetes, smoking, hypertension, dyslipidemia, myocardial infarction, and previous transient ischemic attack between the 2 groups of patients. The multinomial logistic regression procedure selected carotid artery IMT and atrial fibrillation as the only independent factors able to discriminate between lacunar and nonlacunar patients. IMT values were significantly higher in patients with nonlacunar stroke versus both those with lacunar stroke and control subjects. Conclusions-The

“…CT imaging is limited in its ability to detect small infarcts, particularly in the first day after stroke onset. 26 For these reasons, the reported proportion of positive CT scans in patients with a clinical syndrome compatible with a small, deep infarct varies from 33% to 69%…”

Section: Discussionmentioning

confidence: 99%

Epidemiological characteristics of lacunar infarcts in a population.

Sacco

Whisnant

Broderick

et al. 1991

156

Background and Purpose: This study evaluated the characteristics and natural history of patients with lacunar (small, deep) cerebral infarcts in a defined population for comparison of these characteristics to those in patients with nonlacunar infarcts.Methods: This is a population-based study in Rochester, Minnesota, from 1960 to 1984, that used the medical record-linkage system to identify and characterize patients with cerebral infarction.Results: The age-and sex-adjusted average annual incidence rate of lacunar cerebral infarction was 13.4/100,000 persons, accounting for 12% of all first cerebral infarcts. Temporal trends in incidence rates, stroke recurrence rates, prevalence of diabetes mellitus, and causes of death (given survival for 30 days) for cases of lacunar infarction were not significantly different from those for cases of nonlacunar infarction. Hypertension was found in 81% of patients who had a lacunar infarct and in 70% of patients who had a nonlacunar infarct (/7=0.05). A potential cardiac source of embolism was found in 12% of patients who had a lacunar infarct and in 28% of patients who had a nonlacunar infarct (p=0.002). Survival was significantly better after a lacunar infarct than after a nonlacunar infarct Conclusions: Small, deep cerebral infarcts had many of the epidemiological characteristics of other cerebral infarcts but there was a slightly higher frequency of hypertension, significantly lower frequency of a cardiac embolic source, and significantly better survival in patients with lacunar infarction than in those with nonlacunar infarction. (Stroke 1991^22:1236-1241)