Stroke rates in patients with lacunar and large vessel cerebral infarctions

Nadeau, Stephen E.; Jordan, J.Eric; Mishra, Shrikant; Haerer, Armin F.

doi:10.1016/0022-510x(93)90287-9

Cited by 25 publications

(18 citation statements)

References 63 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A lower rate of recurrent stroke after lacunar infarcts compared with other stroke types has been reported in some studies, 10,12,13 whereas no significant difference has been noted in 2 studies. 9,14 In a recent study by Petty et al, 21 stroke subtype was not an independent predictor of long-term recurrence before or after adjustment for age, stroke severity, and diabetes mellitus.…”

Section: Recurrent Strokementioning

confidence: 90%

“…4 Several clinical aspects of lacunar infarcts have been well studied, eg, risk factors, initial clinical features, and short-term prognosis for survival and stroke recurrence. [1][2][3][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] However, the long-term prognosis is less well documented, mainly because the follow-up periods have been limited to Յ5 years, and considerable uncertainty exists about which putative risk factors are independent determinants of survival and recurrent stroke for patients with this subtype of stroke. 15,18,22,23 To address these issues, we examined prognostic features and determinants for survival and stroke recurrence in 178 patients with pure motor stroke from presumed lacunar infarct, followed up to 10 years after stroke onset.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Pure Motor Stroke From Presumed Lacunar Infarct: Long-Term Prognosis for Survival and Risk of Recurrent Stroke

Staaf¹,

Lindgren²,

Norrving³

2001

Stroke

View full text Add to dashboard Cite

Background and Purpose-A low risk of recurrent stroke and death after lacunar infarction has previously been reported, but follow-up has been limited to Յ5 years. Methods-One hundred eighty patients with pure motor stroke, collected between 1983 and 1986 from a hospital-based stroke registry, were followed up until at least 10 years after the index stroke. Two patients were lost to follow-up. Survival status was determined from the official population registry and compared with survival rates of the Swedish population, matched for age and sex. Cox proportional hazards regression analyses were used to identify independent prognostic predictors. Results-During follow-up 106 (60%) of the 178 patients died, most commonly as a result of coronary heart disease.During the first 5 years after the stroke, survival rates were similar to those of the general population. Beyond this time the risk of death was increased among patients with pure motor stroke, with an excess of 10 to 15 percent units compared with the general population. Independent determinants for death were age (PϽ0.01), male sex (PϽ0.01), and nonuse of acetylsalicylic acid (Pϭ0.02). Recurrent stroke occurred in 42 (23.5%) of the patients, corresponding to an annual risk of 2.4%. Hypertension (Pϭ0.025) and diabetes (Pϭ0.024) were independent risk factors for recurrent stroke. Conclusions-For the first few years after lacunar infarct, the risk of death was similar to that of the general population, but later a clear excess of death was observed. The long-term prognosis in lacunar infarction appears less favorable than previously reported.

show abstract

Section: Recurrent Strokementioning

confidence: 90%

mentioning

confidence: 99%

Pure Motor Stroke From Presumed Lacunar Infarct: Long-Term Prognosis for Survival and Risk of Recurrent Stroke

Staaf¹,

Lindgren²,

Norrving³

2001

Stroke

View full text Add to dashboard Cite

show abstract

“…In contrast to earlier studies of the beneficial effects of fasudil, we carried out this study with a microembolism model that is a multiple infarction model. This model should show more peripheral vessel occlusion than would occur by occluding at the origin of the middle cerebral artery (Ohtaki & Tranmer, 1994) or the common carotid artery , and may be far closer to the sites of embolism in patients who have atherothrombotic strokes and lacunar infarctions (Nadeau et al, 1993).…”

Section: Discussionmentioning

confidence: 99%

Neuroprotective properties of a protein kinase inhibitor against ischaemia‐induced neuronal damage in rats and gerbils

Satoh

Ikegaki

Suzuki

et al. 1996

British J Pharmacology

View full text Add to dashboard Cite

1 The neuroprotective properties of fasudil (HA1077), a novel protein kinase inhibitor, were evaluated in two animal models of cerebral ischaemia: transient bilateral carotid artery occlusion in Mongolian gerbils and cerebral microembolization in rats. 2 The cytoprotective effect of fasudil on delayed neuronal death in gerbils was compared with the effects of nimodipine, a calcium channel antagonist and ozagrel, a thromboxane A2 synthetase inhibitor.The average of the neuronal cell density in the ischaemic control group was 17.8+2.1 cells mm-', whereas fasudil (30 mg kg-') significantly diminished the loss of CAl neurones with the average of the neuronal cell density of 101.0+22.0 cells mm-'; nimodipine (10 mg kg-') and ozagrel (30 mg kg-1) did not significantly protect against the ischaemia-induced neuronal loss. 3 In the rat model, the effects of fasudil on the histological and neurological consequences of cerebral microembolization produced via the injection of microspheres were examined. Twenty-four hours after the injection of microspheres into the internal carotid artery, all animals in the control group showed typical symptoms of stroke. Neurological function was significantly improved in the fasudil-treated animals. In the controls, the infarcted area in a cortical slice selected to include the hippocampal area was 0.25 + 0.01 cm2 (mean+s.e.mean) (43.9+2.4% of cortical section of the half hemisphere); the difference was significant compared to the mean area of 32.7+2.8 and 21.5+4.8% observed in rats treated with fasudil (3, 10 mg kg-'), respectively. Fasudil (10 mg kg-') significantly suppressed the increased water content in ischaemic brain tissues (saline-treated rats, 82.4+0.2% vs fasudil-treated rats, 81.0 + 0.4%). 4 These results suggest that: (i) various protein kinases are involved in the pathogenesis of ischaemic injury; and (ii) the inhibition of protein kinases may be efficacious in preventing neuronal death, thus improving neurological function in the brain damage associated with ischaemic stroke.

show abstract

“…In another large follow-up study comparing 1,216 patients with small-vessel disease and 1,221 patients with large-vessel disease, out of the patients with recurrent strokes who initially had small-vessel disease only 28% was small-vessel disease implicated again [34]. In other smaller follow-up studies small-vessel infarcts were followed by both large- and small-vessel infarcts [35, 36]. In our study, 50% of patients with stroke recurrence of known clinical subtype were classified as lacunar stroke again, and the remaining 50% were classified as nonlacunar stroke.…”

Section: Discussionmentioning

confidence: 99%

Lacunar Stroke: Transoesophageal Echocardiographic Factors Influencing Long-Term Prognosis

Kazui¹,

Levi²,

Jones³

et al. 2001

Cerebrovasc Dis

View full text Add to dashboard Cite

Objective: Since little is known concerning factors which may influence long-term prognosis of patients presenting with lacunar stroke, we conducted a longitudinal study of this stroke subtype. Variables likely to affect outcome were assessed at baseline, including those from transoesophageal echocardiographic studies. Methods: Consecutive patients presenting with first-ever lacunar stroke underwent diagnostic workup that included brain CT or MRI, carotid duplex, and transthoracic and transoesophageal echocardiography. An assessment of patients was planned at entry (baseline), and thereafter every 12 months (clinic visit or telephone call), drop-out, or endpoint. The primary endpoint was nonfatal or fatal stroke. Secondary endpoint was death due to any cause. Results: Among 60 consecutive lacunar patients with the mean follow-up period of 3.9 years, 12 patients (20%) had stroke recurrence. The mean annual rate for stroke was 5.2%, and for death 2.8%. For multivariate Cox proportional hazards analysis, the following three variables with the values of p < 0.1 after univariate testing were chosen: age (p = 0.095); aortic atheroma (p = 0.066); and any source of embolism from heart (p = 0.007). Any source of embolism from heart was the only factor which significantly enhanced the risk of stroke recurrence (p = 0.015). Using Kaplan-Meier life table analysis, the curves of percent free of recurrent stroke were significantly different (log rank test p = 0.002). Conclusions: Until the mechanism of lacunar stroke is better understood, it is reasonable to suggest that its investigation and prevention should be directed at all potential causes of future strokes including cardioembolism.

show abstract

Stroke rates in patients with lacunar and large vessel cerebral infarctions

Cited by 25 publications

References 63 publications

Pure Motor Stroke From Presumed Lacunar Infarct: Long-Term Prognosis for Survival and Risk of Recurrent Stroke

Pure Motor Stroke From Presumed Lacunar Infarct: Long-Term Prognosis for Survival and Risk of Recurrent Stroke

Neuroprotective properties of a protein kinase inhibitor against ischaemia‐induced neuronal damage in rats and gerbils

Lacunar Stroke: Transoesophageal Echocardiographic Factors Influencing Long-Term Prognosis

Contact Info

Product

Resources

About