Chronic Kidney Disease in Patients With Lacunar Stroke

Xiao, Lulu; Lan, Wenya; Sun, Wen; Dai, Qiliang; Xiong, Yunyun; Li, Ling; Zhou, Yan; Zheng, Ping; Fan, Wenping; Ma, Nan; Guo, Zhiliang; Chen, Xin; Xie, Xia; Xu, Lili; Zhu, Wusheng; Xu, Gelin; Liu, Fei

doi:10.1161/strokeaha.114.008155

Cited by 66 publications

(32 citation statements)

References 33 publications

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“…The prevalence of BG and CS-PVSs among Chinese with ischemic stroke has previously been reported. 9,20 One study showed that 10.7% of subjects had >40 BG-PVSs, 20 and in another, ≈40% of subjects had >10 BG or CS-PVSs. 9 These 2 studies, however, were purely based on patients with lacunar stroke subtype.…”

Section: Discussionmentioning

confidence: 99%

“…9,20 One study showed that 10.7% of subjects had >40 BG-PVSs, 20 and in another, ≈40% of subjects had >10 BG or CS-PVSs. 9 These 2 studies, however, were purely based on patients with lacunar stroke subtype. 9,20 In a large cohort of neurologically healthy Japanese individuals, a low prevalence of >20 BG-PVS and CS-PVS of 2.5% and 22.6% was similarly noted.…”

Section: Discussionmentioning

confidence: 99%

“…9 These 2 studies, however, were purely based on patients with lacunar stroke subtype. 9,20 In a large cohort of neurologically healthy Japanese individuals, a low prevalence of >20 BG-PVS and CS-PVS of 2.5% and 22.6% was similarly noted. 8 Such low prevalence of >20 PVSs in the HKU cohort would have limited the statistical power when determining the clinical correlates of PVSs and attributed to some of the differences observed when compared with OXVASC.…”

Section: Discussionmentioning

confidence: 99%

“…1 They are most frequently found in the inferior basal ganglia (BG), centrum semiovale (CS), and midbrain. 2 Although it is normal to have a few visible PVSs on neuroimaging, 3 an increased burden of BG and CS-PVSs has been associated with increasing age, 4–7 hypertension, 4–6,8 renal impairment, 9 white matter hyperintensity (WMH), 4–6,8,10 and lacunes. 4,6,8,10 BG-PVSs in addition have also been associated with male sex, 6 mean systolic and diastolic blood pressure, 8,11 deep or infratentorial cerebral microbleeds, 7,8 and also stroke caused by small vessel occlusion.…”

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confidence: 99%

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Clinical Correlates, Ethnic Differences, and Prognostic Implications of Perivascular Spaces in Transient Ischemic Attack and Ischemic Stroke

Lau

Lovelock

et al. 2017

Stroke

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Clinical Correlates, Ethnic Differences, and Prognostic Implications of Perivascular Spaces in Transient Ischemic Attack and Ischemic Stroke

Lau

Lovelock

et al. 2017

Stroke

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“…EPVSs were defined as round, oval or linear‐shaped lesions less than 3 mm in size with the same signal characteristics as cerebrospinal fluid and without a hyperintense rim . Since EPVSs at the basal ganglia level have been known to be closely related to cSVD, the burdens of EPVSs were categorized into a 0–10 group, an 11–25 group and a >25 group by the number of EPVSs in the basal ganglia . Intracranial atherosclerosis (ICAS) was defined as an occlusion or more than 50% stenosis of intracranial vessels on flight MRA images .…”

Section: Methodsmentioning

confidence: 99%

Left ventricular ejection fraction is associated with small vessel disease in ischaemic stroke patients

Nam

Kwon

Kim

et al. 2019

Euro J of Neurology

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Background and purpose The purpose was to evaluate the association between the left ventricular ejection fraction (LVEF) and cerebral small vessel disease (cSVD) in ischaemic stroke patients. Methods Consecutive first‐ever ischaemic stroke patients between 2010 and 2013 were included. White matter hyperintensity (WMH) volumes were rated using both the Fazekas score and quantitative methods on fluid‐attenuated inversion recovery images. As spectra of cSVD, lacunes, cerebral microbleeds (CMBs) and enlarged perivascular spaces (EPVSs) were also evaluated. To assess the dose–response relationship between LVEF and cSVD, the burdens of each radiological marker and the total cSVD score were rated. Results A total of 841 patients were included [median WMH volume 2.98 (1.22–10.50) ml; the frequencies of lacunes, CMBs and moderate to severe EPVSs were 38%, 31% and 35%, respectively]. In the multivariate analysis about predictors of WMH volumes, the LVEF (B = −0.052, P < 0.001) remained significant after adjusting for confounders. LVEF was also a predictor of lacunes [adjusted odds ratio (aOR) 0.978, P = 0.012], CMBs (aOR = 0.96, P < 0.001) and moderate to severe EPVSs (aOR = 0.94, P < 0.001) after adjusting for their confounders. The LVEF values were negatively correlated with the burdens of lacunes (P = 0.026), CMBs (P < 0.001) and EPVSs (P = 0.002). The total cSVD score also showed a negative association with LVEF in a dose–response manner (P < 0.001). Conclusions The burden of cSVD is negatively correlated with the LVEF in a dose–response manner. Our results suggest clues for further studies about determining the pathophysiology of cSVD.

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Advances in Understanding the Pathophysiology of Lacunar Stroke

et al. 2018

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troke is the second leading cause of death in the world and the leading cause of disability in the United States. 1 Among ischemic strokes, there are different subtypes, including large artery atherosclerosis, cardioembolism, and cerebral small vessel disease (CSVD). Although CSVD has several clinical and radiographic manifestations, lacunar stroke (LS) is prototypical and accounts for 20% to 30% of ischemic strokes. 2,3 Clinically, LS can manifest with several syndromes depending on lesion location. 4 Silent LSs are found in 20% to 50% of healthy elderly people. 5 Lacunar strokes are particularly burdensome, with a 20% recurrence rate, 25% fiveyear mortality, and associated morbidities, such as vascular cognitive impairment. 3 Lacunar strokes, appropriately named given their propensity to form cavities (lacunes), were first described in 1838 (Figure 1). 3 More recently, the Standards for Reporting Vascular Changes on Neuroimaging definitions were developed to standardize terms that describe the appearance of sequelae of CSVD, including recent small subcortical infarcts, lacunes, white matter hyperintensities (WMHs), perivascular spaces, microbleeds, and brain atrophy, on imaging. 6 Lacunar strokes primarily encompass 2 terms: recent small subcortical infarcts, defined as recent infarctions in the territory of 1 perforating arteriole with imaging features or clinical symptoms consistent with occurrence in the previous few weeks, and lacunes, defined as round or ovoid, subcortical, fluid-filled cavities 3 to 15 mm in diameter, consistent with previous acute small subcortical infarcts or hemorrhages in the territory of 1 perforating arteriole. 6 Although this review focuses on LS, other abnormalities that result from CSVD are relevant because there are interrelated mechanisms and treatment implications. For example, recent small subcortical infarcts can also contribute to WMH, 3 and many intracerebral hemorrhages (ICHs) likely result from similar vessel abnormalities. 7 This suggests that patients with LS may have an increased risk for bleeding when taking antithrombotic medications. IMPORTANCE Stroke is the second leading cause of death in the world, and nearly one-third of ischemic strokes are lacunar strokes (LSs) or small subcortical infarcts. Although smaller in size, they create large problems, leaving many patients with intellectual and physical disabilities. Because there are limitations in understanding the underlying pathophysiology of LS, the development of novel therapies has been slow.OBSERVATIONS When the term lacune was described in the 1800s, its underlying pathophysiological basis was obscure. In the 1960s, C. Miller Fisher, MD, performed autopsy studies that showed that vessels supplying lacunes displayed segmental arteriolar disorganization, characterized by vessel enlargement, hemorrhage, and fibrinoid deposition. For these pathologic changes, he coined the term lipohyalinosis. Since that time, few attempts have been made to reconcile this pathologic description with modern mechanisms of cerebr...

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Chronic Kidney Disease in Patients With Lacunar Stroke

Cited by 66 publications

References 33 publications

Clinical Correlates, Ethnic Differences, and Prognostic Implications of Perivascular Spaces in Transient Ischemic Attack and Ischemic Stroke

Clinical Correlates, Ethnic Differences, and Prognostic Implications of Perivascular Spaces in Transient Ischemic Attack and Ischemic Stroke

Left ventricular ejection fraction is associated with small vessel disease in ischaemic stroke patients

Advances in Understanding the Pathophysiology of Lacunar Stroke

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