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Impaired cerebrovascular reactivity as a risk marker for first-ever lacunar infarction: A case-control study
C Molina1, J A Sabín, J Montaner
1Cerebrovascular Unit, Hospital Vall d'Hebrón, Barcelona, Spain. cmolc@meridian.es
Insights
Impaired cerebrovascular reactivity (CVR) is a significant risk marker for first-ever lacunar infarction. Lower CVR levels in patients indicate a higher risk of stroke, highlighting its importance in small-vessel disease assessment.
Area of Science:
- Neurology
- Vascular Medicine
- Medical Imaging
Background:
- Small vessel disease affects arteries and arterioles, impacting brain health.
- Assessing small artery function is crucial for understanding diffuse arteriolosclerosis.
- Cerebrovascular reactivity (CVR) offers insights into small vessel disease.
Purpose of the Study:
- To determine if cerebrovascular reactivity (CVR) is a risk marker for first-ever symptomatic lacunar infarction.
- To investigate the role of CVR in patients with small-vessel disease.
Main Methods:
- Prospective evaluation of 46 lacunar infarction patients and 46 controls.
- Cerebral hemodynamics assessed using transcranial Doppler ultrasonography.
- CVR measured via acetazolamide challenge (Diamox test).
Main Results:
- Significantly lower CVR in lacunar infarction patients (50.0%) vs. controls (65.2%).
- Male sex, older age, and MRI-confirmed lacunar infarction independently predicted reduced CVR.
- Hypertension history and reduced CVR were significant predictors of lacunar infarction.
Conclusions:
- Impaired CVR is identified as a risk marker for first-ever lacunar infarction.
- CVR assessment can aid in identifying individuals at risk for lacunar stroke.
- Findings emphasize the clinical relevance of CVR in small-vessel disease management.
Background And Purpose:
Functional assessment of small arteries and arterioles could provide valuable information regarding the extent of diffuse arteriolosclerosis in patients with small-vessel disease. Therefore we attempted to clarify the role of cerebrovascular reactivity (CVR) as a risk marker for first-ever symptomatic lacunar infarction.
Methods:
Forty-six patients with lacunar infarction and 46 sex- and age-matched control subjects were prospectively evaluated. Cerebral hemodynamics were studied with transcranial Doppler ultrasonography. CVR was examined by calculating the percent increase in mean flow velocity occurring after 15 mg/kg acetazolamide administration (Diamox test).
Results:
CVR was significantly (P<0.0001, Student's t test) lower in cases (50.0+/-12. 7%) as compared with control subjects (65.2+/-12.4%). A multiple logistic regression analysis identified male sex (odds ratio [OR] 2. 3, P=0.02), age (OR 3.6, P<0.005), and the presence of lacunar infarction on magnetic resonance imaging (OR 5.3, P<0.001) as significant and independent factors associated with a reduction of CVR. Moreover, a cut-point of 55.6% (sensitivity 67%, specificity 82%) was established as the threshold value for distinguishing between pathological and normal CVR. CVR was significantly (P=0.02) lower in patients with multiple (46.38+/-12.6%) than with single (54. 83+/-11.58%) lacunar infarction. In addition, a trend of negative correlation was found between CVR and the number of lacunar infarctions (r=-0.26, P=0.08). In the multiple logistic model, history of hypertension (OR 7.24; 95% confidence interval 2.95 to 17. 79) and CVR (OR 0.8; 95% confidence interval 0.81 to 0.93) emerge as significant and independent predictors of first-ever lacunar infarction.
Conclusions:
These data suggest that impaired CVR is a risk marker for first-ever lacunar infarction.