Risk Factors for Lacunar Strokes with Visible Cerebral Lesions on Computed Tomography Scan

Muscari, Antonio; Conte, Camilla; Esposti, Daniela Degli; Faccioli, Luca; Falcone, Roberta; Kolce, Besar; Marabini, Lisa; Puddu, Giovanni M.; Rosticci, Martina; Spinardi, Luca; Veronesi, Maddalena; Borghi, Claudio; Zoli, Marco

doi:10.1016/j.jstrokecerebrovasdis.2016.01.050

Cited by 3 publications

(2 citation statements)

References 20 publications

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“…We identified clinical factors associated with presence of a new lacunar lesion on follow-up CT including higher systolic blood pressure in the whole study population, NIHSS score <7, and higher blood glucose in the LACS subgroup. Similar to our results, previous studies identified systolic blood pressure as variably associated with subsequent lacunar infarction, 19,20 and diabetes mellitus but not baseline blood glucose was also associated with lacunar infarction. 21 Among radiological factors, preexisting lacunes were associated with a new lacunar infarction both in LACS and non-LACS populations.…”

Section: Strokesupporting

confidence: 92%

Improving Clinical Detection of Acute Lacunar Stroke

Arba

Mair

Phillips

et al. 2020

Stroke

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Background and Purpose— We aim to identify factors associated with imaging-confirmed lacunar strokes and improve their rapid clinical identification early after symptom onset using data from the IST-3 (Third International Stroke Trial). Methods— We selected patients likely to have lacunar infarcts as those presenting with: Oxfordshire Community Stroke Project lacunar syndrome; a random sample with National Institutes of Health Stroke Scale (NIHSS) score <7; and recent lacunar infarct identified on imaging by IST-3 central blinded expert panel. An independent reviewer rated brain scans of this sample and classified visible infarcts according to type, size, and location. We investigated factors associated with presence of lacunar infarct on a 24 to 48 hour follow-up scan using multivariable logistic regression and calculated sensitivity and specificity of Oxfordshire Community Stroke Project alone and in combination with NIHSS score <7. Results— We included 568 patients (330 lacunar syndrome; 147 with NIHSS score <7; 91 with lacunar infarct on baseline imaging, numbers exclude overlaps between groups), mean (±SD) age, 73.2 (±13.6) years, 316 (56%) males, and median NIHSS score 5 (IQR, 4–8). On 24 to 48 hour scan, 138 (24%) patients had lacunar infarcts, 176 (31%) other infarct subtypes, 254 (45%) no visible infarct. Higher baseline systolic blood pressure (odds ratio, 1.01 [95% CI, 1.01–1.02]) and preexisting lacunes (odds ratio, 2.29 [95% CI, 1.47–3.57) were associated with recent lacunar infarcts. Sensitivity and specificity of lacunar syndrome was modest (58% and 45%, respectively), but adding NIHSS score <7 increased specificity (99%), positive and negative predictive values (97% and 87%, respectively). Conclusions— In patients presenting within 6 hours of stroke onset, adding NIHSS score <7 to Oxfordshire Community Stroke Project lacunar syndrome classification may increase specificity for identifying lacunar stroke early after stroke onset. Our findings may help selection of patients for clinical trials of lacunar stroke and should be validated externally. Registration— URL: http://www.controlled-trials.com/ ; Unique identifier: ISRCTN25765518.

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Section: Strokesupporting

confidence: 92%

Improving Clinical Detection of Acute Lacunar Stroke

Arba

Mair

Phillips

et al. 2020

Stroke

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“…These factors also affect the 3 primary measures incorporated into the present review and meta‐analyses. 137 , 163 , 231 , 232 , 233 Although blood pressure or hypertension may be a confounding factor, many studies adjusted for this. However, it is worth noting that we did not have any randomized‐controlled trials in our meta‐analyses, which may partly explain discrepancies regarding the impact of hypertension on cSVD.…”

Section: Discussionmentioning

confidence: 99%

Associations of Cerebrovascular Regulation and Arterial Stiffness With Cerebral Small Vessel Disease: A Systematic Review and Meta‐Analysis

Scheuermann,

Parr,

Schulze

et al. 2023

JAHA

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Background Cerebral small vessel disease (cSVD) is a major contributing factor to ischemic stroke and dementia. However, the vascular pathologies of cSVD remain inconclusive. The aim of this systematic review and meta‐analysis was to characterize the associations between cSVD and cerebrovascular reactivity (CVR), cerebral autoregulation, and arterial stiffness (AS). Methods and Results MEDLINE, Web of Science, and Embase were searched from inception to September 2023 for studies reporting CVR, cerebral autoregulation, or AS in relation to radiological markers of cSVD. Data were extracted in predefined tables, reviewed, and meta‐analyses performed using inverse‐variance random effects models to determine pooled odds ratios (ORs). A total of 1611 studies were identified; 142 were included in the systematic review, of which 60 had data available for meta‐analyses. Systematic review revealed that CVR, cerebral autoregulation, and AS were consistently associated with cSVD (80.4%, 78.6%, and 85.4% of studies, respectively). Meta‐analysis in 7 studies (536 participants, 32.9% women) revealed a borderline association between impaired CVR and cSVD (OR, 2.26 [95% CI, 0.99–5.14]; P =0.05). In 37 studies (27 952 participants, 53.0% women) increased AS, per SD, was associated with cSVD (OR, 1.24 [95% CI, 1.15–1.33]; P <0.01). Meta‐regression adjusted for comorbidities accounted for one‐third of the AS model variance ( R 2 =29.4%, P moderators =0.02). Subgroup analysis of AS studies demonstrated an association with white matter hyperintensities (OR, 1.42 [95% CI, 1.18–1.70]; P <0.01). Conclusions The collective findings of the present systematic review and meta‐analyses suggest an association between cSVD and impaired CVR and elevated AS. However, longitudinal investigations into vascular stiffness and regulatory function as possible risk factors for cSVD remain warranted.

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