Irregularly shaped lacunar infarction: risk factors and clinical significance

Abstract

Objective Our study focused on acute lacunar infarct shapes to explore the risk factors and clinical significance of irregularly shaped lacunar infarctions. Methods Based on the shape of their acute lacunar infarct, patients (n=204) were classified into the “regular” group or “irregular” group. The characteristics of the lacunar infarction were compared between the regular and irregular groups, between patients with and without neurological deterioration, and between patients with different modified Rankin scale (mRS) scores. The risk factors for irregularly shaped lacunar infarctions, neurological deterioration, and high mRS scores were identified. Results Blood pressure variability (BPV) was an independent risk factor for irregularly shaped lacunar infarction. Infarction size, prevalence of advanced leukoaraiosis, and irregularly shaped lacunar infarcts were independent risk factors for higher mRS scores. Conclusions The irregularly shaped lacunar infarcts were correlated with BPV. Irregularly shaped lacunar infarctions and leukoaraiosis may be associated with unfavorable clinical outcomes.

Twenty-Four-Hour Ambulatory Blood Pressure Variability Associated With Cerebral Small Vessel Disease MRI Burden and Its Progression in Inpatients With Cerebrovascular Disease

“…Coincidently, we identified SBP SD during daytime an SBP wSD as significant risk factors for total cSVD burden and SBP wSD as a significant predictor for the cSVD progression in the present study, while other BPV metrics were not. Similar results were reported in other studies about BPV and cSVD as well as other target organ damage ( 15 , 28 , 32 ), probably because SBP has more impact on vascular risk including cSVD ( 33 – 35 ). In addition, different BPV metrics in different time period may not manifest the same aspects of blood pressure and may relate differently to specific target prognosis ( 35 , 36 ).…”

“…Although it was believed that traditional vascular risk factors, such as male, smoking, diabetes mellitus, high low-densitylipoprotein cholesterol level were associated with cerebrovascular events and cSVD (20,28,(40)(41)(42)(43), there was no statistical difference of these risk factors among different cSVD score groups, or between the cSVD progression and no-progression group in our study. Our finding was consistent with the results in former studies (4,15,44,45).…”

“…Several studies have investigated the relationship between BPV and individual cSVD markers, including lacunar infarcts, white matter lesion, EPVS and microbleeds, which identified higher BPV related to more severe cSVD markers ( 12 – 14 , 28 , 29 ). However, it is not uncommon that multiple cSVD markers are found simultaneously in a single patient and all the markers often share the same etiology and pathogenesis, thus total cSVD score comprising different markers has been used by different teams to represent the overall cSVD severity ( 4 , 5 , 15 ).…”

BPV associated with imaging features of SSI on MRI

“…The maximum of SBP was significantly increased in the non-round lesion group and the small lacunar lesion group. Hypertension, SBP and DBP have similar epidemiological features in both regular and irregular lacunar infarction, whereas BPV is more pronounced in irregular lesions (Feng et al, 2013). The results of this study suggest that long-term BPV is closely related to nonround lesions.…”

Lacunar strokes: does shape matter?

“…Lacunes with ovoid or spheroid, regular shapes may reflect involvement of smallest arteries 5 . In this issue of Arquivos de Neuro-Psiquiatria, Feng et al 6 evaluated clinical and imaging features as well as prognosis of 204 Chinese patients admitted with acute lacunar infarcts, defined as hypointense focal lesions in T1-weighted images and hyperintense focal lesions in T2-weighted, FLAIR, and DWI images with a diameter ranging from 3 mm to 20 mm. Radiologists (unaware of clinical characteristics) classified infarcts as regular or irregular by visual inspection of MRI images.…”