Risk Factors and Outcome of Patients With Symptomatic Intracranial Stenosis Presenting With Lacunar Stroke

Abstract

Background and Purpose We hypothesized that patients with intracranial stenosis with lacunar stroke presentations would face lower risks of recurrent stroke than those with index non-lacunar strokes, and that their recurrent strokes would predominantly be lacunar. Methods We analyzed subjects enrolled with an index stroke into the Warfarin Aspirin Symptomatic Intracranial Disease (WASID) trial. The index stroke was classified as lacunar or non-lacunar. The primary endpoint was recurrent ischemic stroke. Cox proportional hazard models were generated with stratification for severity of stenosis. Results 347 subjects were enrolled after an index stroke, 38 were lacunar and 309 were non-lacunar. Over a mean follow-up of 1.8 years there was no significant difference in stroke recurrence between patients whose index stroke was lacunar (7/38; 18%) vs. non-lacunar (69/309; 22%) (HR 0.79, 95%CI:0.36–1.71). Further, no significant differences were found when groups were stratified by 50–69% stenosis (HR 0.50, 95%CI:0.12–2.1) and ≥70% stenosis (HR 0.87, 95%CI:0.34–2.2). Of the 7 recurrent strokes in patients whose index stroke was lacunar, all 7 were non-lacunar and 3 were in the territory of the stenotic artery. Conclusions In patients with symptomatic intracranial stenosis, the risk of recurrent stroke was similar in patients who presented with lacunar and non-lacunar strokes, and recurrent strokes in patients presenting with lacunar stroke were typically non-lacunar. These findings suggest that the pathophysiology of these strokes is related to the stenosis rather than small vessel disease. Patients presenting with lacunar strokes should be included in trials investigating secondary prevention for symptomatic intracranial stenosis.

Correlation between ABCD, ABCD2 Scores and Craniocervical Artery Stenosis in Patients with Transient Ischemic Attack

“…However, according to previous studies, whether diabetes correlates with large artery stenosis remained controversial. Many studies indicated a positive relationship despite hyperglycemia or hyperinsulinemia mainly leads to small vessels injury [23,24]. It probably indicated that even the ABCD score already provided reasonable accuracy in artery stenosis prediction; the ABCD2 score could still be expected to be superior although our study failed to confirm it.…”

Dimensions of Subcortical Infarcts Associated with First- to Third-Order Branches of the Basal Ganglia Arteries

“…Recently, it has been proposed that this type of stroke may be ‘a manifestation of non-atherothrombotic occlusive small vessel disease'. Further, these infarcts may require different investigations and treatment [6,7,8]. The mechanism of these infarcts is a point of controversy with other investigators pointing to atherosclerotic disease involving the larger arteries [7,9,10] or embolism [11,12].…”

“…Further, these infarcts may require different investigations and treatment [6,7,8]. The mechanism of these infarcts is a point of controversy with other investigators pointing to atherosclerotic disease involving the larger arteries [7,9,10] or embolism [11,12]. Given the variations in the definition of lacunar infarcts [10,13], there is significant interest in refining the imaging features of such infarcts.…”

Distinct non-cerebrovascular risk factors for ischemic lacunar stroke and non-lacunar stroke: preliminary results

“…Nearly one quarter of ischemic strokes are caused by lacunar infarcts, resulting from the occlu-sion or leakiness of one of the small perforating arteries supplying the deep subcortical areas of the brain (Bejot et al, 2008). The responsible arterial pathology remains poorly understood, with proposed mechanisms including lipohyalinosis, arteriosclerosis, poor cerebral blood flow, vasospasm, and abnormal endothelial function (Kolominsky-Rabas et al, 2001;Khan et al, 2012). There is growing evidence to suggest that lacunar arteriopathy may differ from the atherothromboembolic processes that lead to occlusion of large intracranial and extracranial arteries, causing most other ischemic strokes (Jickling et al, 2012).…”

“…Vascular risk factors of LS and NLS relate directly to the underlying etiologies of the two subtypes (Kazui et al, 2000;Khan et al, 2012;Park et al, 2012). However, relatively little is known of the non-vascular risk factors contributing to ischemic stroke (Petty et al, 2000;Cokar et al, 2008;Prodan et al, 2008;Castilla-Guerra et al, 2009;Jackson et al, 2010;Zhang et al, 2011).…”