Systemic small-vessel disease is not exclusively related to lacunar stroke. A pilot study

Luijckx, Gert-Jan; Boiten, Jelis; Kroonenburgh, Maarten van; Kitslaar, Peter J.E.H.M.; Kurvers, H. A. J. M.; Daemen, M.A.R.C.; Leunissen, Karel M.L.; Beintema, M; Lodder, J.

doi:10.1016/s1052-3057(98)80021-9

Cited by 9 publications

(16 citation statements)

References 20 publications

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“…Nine of the 37 papers used asymptomatic infarcts seen on brain imaging 9 10 27 29 – 31 36 – 38. The other 28 papers assessed some measure of clinical stroke of which only 9/28 papers subtyped stroke into haemorrhagic or ischaemic 8 14 15 23 26 32 – 34 40. Of these nine papers, six further subtyped ischaemic strokes,8 14 15 23 34 40 but only one paper reported retinal microvascular abnormality differences between the ischaemic stroke subgroups 34…”

Section: Resultsmentioning

confidence: 99%

Retinal microvascular abnormalities and stroke: a systematic review

Doubal

Hokke

Wardlaw

2009

Journal of Neurology, Neurosurgery & Psychiatry

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Background: Lacunar strokes account for 25% of ischaemic strokes, but their precise aetiology is unknown. Similarities between the retinal and cerebral small vessels mean that clarification of the exact relationship between retinal microvascular abnormalities and stroke, and particularly with stroke subtypes, may aid understanding of the aetiology of lacunar stroke and stroke risk. Methods: A systematic review of the literature was performed by searching Medline and Embase to October 2007 for studies in humans that investigated the association between retinal microvascular abnormalities and prevalent or incident stroke. Data and calculated summary risk ratios (sRR) were extracted for associations between retinal microvascular abnormalities and stroke, including stroke subtypes where possible, adjusted for key variables. 37 papers from 22 different studies were included with 62 975 subjects (mean age 62 years) among whom there were 2893 strokes. Stroke identification and diagnosis methods varied. Results: Retinopathy was associated with incident stroke (sRR 2.1, 95% CI 1.7 to 2.6) and prevalent stroke (sRR 2.5, 95% CI 1.4 to 4.3). Incident stroke was also associated with retinal artery embolism (sRR 2.9, 95% CI 1.6 to 5.1) and venular widening (sRR 1.4, 95% CI 1.1 to 1.7). There was significant heterogeneity between studies for some associations. There were no data on retinal microvascular abnormalities and haemorrhagic versus ischaemic stroke or ischaemic stroke subtypes. Conclusions: Retinal microvascular abnormalities are associated with stroke, but more data are required to clarify associations between specific types of retinal microvascular abnormality and stroke, as well as between different stroke subtypes. Future retinal-stroke studies should concentrate on carefully diagnosing and accurately sub-typing ischaemic stroke.Lacunar ischaemic stroke accounts for 25% of all ischaemic strokes, 1 but its precise aetiology is unknown.2 Possible causes include atherothromboembolism, 3 intracranial large artery stenosis, intrinsic microvascular atheroma, or endothelial dysfunction manifesting either through ischaemia or failure of the blood-brain barrier. 4 The cerebral blood vessels that, when diseased, give rise to lacunar stroke share many characteristics with retinal vessels, 5 being developmentally related during embryogenesis and of similar diameter (50-250 mm). Retinal vessels are visibly affected by known risk factors for stroke such as diabetes and hypertension.6 Therefore, determining any association between retinal microvascular abnormalities and stroke may improve understanding of the nature of the cerebral small vessel changes underlying lacunar ischaemic stroke and aid cerebrovascular and cardiovascular risk profiling.Several studies have examined a possible link between stroke and the retina, including large epidemiological studies in community-dwelling populations and small detailed studies of patients with specific diseases attending tertiary hospitals. The presence and strength of any repo...

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Section: Resultsmentioning

confidence: 99%

Retinal microvascular abnormalities and stroke: a systematic review

Doubal

Hokke

Wardlaw

2009

Journal of Neurology, Neurosurgery & Psychiatry

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“…The peripheral circulation provides a valuable method of examining systemic endothelial dysfunction outside the territory affected by the recent stroke. Cerebral small vessel disease may be a systemic small vessel problem affecting multiple organs 8,50 in the same way that large artery atheroma is rarely a disease of only 1 large artery, and therefore it is legitimate and necessary to study small vessel disease in multiple organs, not just the brain.…”

Section: Stevenson Et Al Endothelial Dysfunction In Lacunar Stroke E439mentioning

confidence: 99%

A Systematic Review of Dynamic Cerebral and Peripheral Endothelial Function in Lacunar Stroke Versus Controls

Stevenson

Doubal

Shuler

et al. 2010

Stroke

105

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Background and Purpose-The etiology of cerebral small vessel disease is unknown. An association with endothelial dysfunction has been suggested. We systematically assessed all relevant studies of dynamic endothelial function in patients with lacunar stroke as a marker of small vessel disease. Methods-We searched for studies of cerebral or peripheral vascular reactivity in patients with lacunar or cortical (ie, large artery atheromatous) ischemic stroke or nonstroke control subjects. We calculated standardized mean difference (SMD) in vascular reactivityϮ95% CIs between small vessel disease and control groups. Results-Sixteen publications (974 patients) were included. In lacunar stroke, cerebrovascular reactivity (nϭ534) was reduced compared with age-matched normal (SMD Ϫ0.94, 95% CI Ϫ1.17 to Ϫ0.70), but not ageϩrisk factor-matched control subjects (SMD 0.08, 95% CI Ϫ0.36 to 0.53) or cortical strokes (SMD Ϫ0.29, 95% CI Ϫ0.69 to 0.11); forearm flow-mediated dilatation (nϭ401) was reduced compared with age-matched normal control subjects (SMD Ϫ1.04, 95% CI Ϫ1.33 to Ϫ0.75) and ageϩrisk factor-matched control subjects (SMD Ϫ0.94, 95% CI Ϫ1.26 to Ϫ0.61), but not cortical strokes (SMD Ϫ0.23, 95% CI Ϫ0.55 to 0.08). Conclusions-Endothelial dysfunction is present in patients with lacunar stroke but may simply reflect exposure to vascular risk factors and having a stroke, because a similar degree of dysfunction is found in cortical (large artery atheromatous) stroke. Current data do not confirm that endothelial dysfunction is specific to small vessel stroke. Future studies should include control subjects with nonlacunar stroke. (Stroke. 2010;41:e434-e442.)

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“…7 The relative importance of these mechanisms has been disputed. 4,12,13 Emboli enter perforating arteries in experimental models.…”

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confidence: 99%

Imaging appearance of the symptomatic perforating artery in patients with lacunar infarction: Occlusion or other vascular pathology?

Wardlaw

Dennis

Warlow

et al. 2001

Annals of Neurology

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Lacunar infarction is associated with distinct clinical features. It is thought to result from occlusion of a deep perforating artery in the basal ganglia, centrum semiovale, or brain stem. However, occluded perforating arteries have only rarely been observed at postmortem in patients with lacunar stroke and have not been noted previously on imaging despite the increasing sophistication of the techniques. We observed nine patients with lacunar stroke imaged with computed tomography and magnetic resonance imaging in whom we observed a linear structure with density or signal features consistent with an occluded (or at least abnormal) perforating artery associated with the relevant lacunar infarct. The appearance might also have been caused by a leak of blood and fluid into the perivascular space around the artery, as in several patients the width of the tubular vessel-like structure (>1 mm in diameter) was greater than the expected width of a perforating artery (<0.8 mm in diameter). This interpretation is supported by the fact that the area of infarction was usually around the abnormal vessel, not at the end of it. We describe the patients' clinical and imaging features, and discuss alternative explanations for the imaging appearance and the implications for gaining insights into the cause of lacunar infarction.

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Systemic small-vessel disease is not exclusively related to lacunar stroke. A pilot study

Cited by 9 publications

References 20 publications

Retinal microvascular abnormalities and stroke: a systematic review

Retinal microvascular abnormalities and stroke: a systematic review

A Systematic Review of Dynamic Cerebral and Peripheral Endothelial Function in Lacunar Stroke Versus Controls

Imaging appearance of the symptomatic perforating artery in patients with lacunar infarction: Occlusion or other vascular pathology?

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