The Potential Impact of Neuroimaging and Translational Research on the Clinical Management of Lacunar Stroke

Abstract

Lacunar infarcts represent one of the most frequent subtypes of ischemic strokes and may represent the first recognizable manifestation of a progressive disease of the small perforating arteries, capillaries, and venules of the brain, defined as cerebral small vessel disease. The pathophysiological mechanisms leading to a perforating artery occlusion are multiple and still not completely defined, due to spatial resolution issues in neuroimaging, sparsity of pathological studies, and lack of valid experimental models. Recent advances in the endovascular treatment of large vessel occlusion may have diverted attention from the management of patients with small vessel occlusions, often excluded from clinical trials of acute therapy and secondary prevention. However, patients with a lacunar stroke benefit from early diagnosis, reperfusion therapy, and secondary prevention measures. In addition, there are new developments in the knowledge of this entity that suggest potential benefits of thrombolysis in an extended time window in selected patients, as well as novel therapeutic approaches targeting different pathophysiological mechanisms involved in small vessel disease. This review offers a comprehensive update in lacunar stroke pathophysiology and clinical perspective for managing lacunar strokes, in light of the latest insights from imaging and translational studies.

Neuroprotective Effect of Macrophage Migration Inhibitory Factor (MIF) in a Mouse Model of Ischemic Stroke

“…Further study focusing on the mechanism of the anti-apoptotic and pro-inflammatory processes of the MIF involving activating T-cells, macrophage, and monocytes is warranted. Fourth, the MCAO model cannot explain the lacunar infarcts of which the pathophysiology prognosis is different from other ischemic cerebral infarcts; thus reproducing the animal model is difficult [41]. Further study investigating the effect of the MIF in lacunar infarction is needed.…”

Prediction Model of Hemorrhage Transformation in Patient with Acute Ischemic Stroke Based on Multiparametric MRI Radiomics and Machine Learning

“…In future research, we will try to use deep learning methods to extract deeper potential features with a view to achieving better prediction results. Moreover, it is worth noting that the pathophysiology, prognosis and clinical features of acute small-vessel ischemic strokes are different from other acute cerebral infarcts [ 33 ]. Therefore, the results obtained in the study could only be extrapolated to non-lacunar acute cerebral infarcts.…”

Neuroprotective Effects of VEGF in the Enteric Nervous System

“…In Alzheimer’s disease, this pro-angiogenic effect could be used positively in the CNS [ 28 ]. Vascular dementia due to lacunar infarcts associated with systemic small vessel disease could also benefit from increased VEGF [ 30 ]. However, vasculogenesis is also crucial for tumor growth and other diseases [ 15 ].…”

“…As already described for the adult brain, it is necessary to identify and stimulate different processes involved in neurorepair like angiogenesis, neurogenesis, synaptic plasticity and endogenous neurorepair phenomena in the ENS [ 29 ]. The pro-angiogenic effects of VEGF could also have a positive impact vascular dementia as systemic small vessel diseases are thought to promote dementia and extrapyramidal symptoms and probably also affect the gut-brain axis [ 30 ].…”