Related Experiment Videos
Does a relationship exist between carotid stenosis and lacunar infarction?
J Tejada1, E Díez-Tejedor, L Hernández-Echebarría
1Division of Neurology, Hospital de León, 24008 León, Spain. jtejada@hleo.insalud.es
Insights
Carotid stenosis (CS) plays a significant role in the development of lacunar infarction (LI), particularly when it affects the ipsilateral side. This finding challenges the traditional view of CS in lacunar stroke patients.
Area of Science:
- Neurology
- Vascular Neurology
- Cerebrovascular Disease
Background:
- Carotid stenosis (CS) is often considered unrelated to lacunar infarction (LI).
- This study investigates the association between CS and LI, differentiating between single and multiple lacunar events.
Purpose of the Study:
- To determine the relationship between carotid stenosis and lacunar infarction.
- To assess differences between single and multiple lacunar infarctions in relation to CS.
Main Methods:
- Classified 330 patients with first-ever cerebral infarction into LI and non-LI groups.
- Identified single and multiple LIs, with further classification of multiple LIs by hemispheric distribution.
Main Results:
- Isolated ipsilateral CS was significantly more frequent in the LI group (OR, 5.5).
- A significant relationship was found between unilateral multiple LIs and homolateral CS >70% (OR, 4.4).
- Multivariate analysis identified left ventricular hypertrophy and homolateral CS >75% as predictors of unilateral multiple LI.
Conclusions:
- The high incidence of ipsilateral CS in patients with LI suggests a crucial role for CS in LI development.
- CS is an important factor in the pathogenesis of lacunar infarction, especially in cases with multiple lesions.
Background And Purpose:
The presence of carotid stenosis (CS) in a patient with lacunar stroke is usually considered an indication of atherosclerosis and not directly related to the development of this infarction subtype. This study was designed to determine the relationship between CS and lacunar infarction (LI) and to assess the differences between single and multiple LIs.
Methods:
We classified 330 patients with a first-ever cerebral infarction in the carotid territory into LI and non-LI (NLI) groups. In the LI group, patients with a single LI and those with multiple LIs were identified. In this last subgroup, 2 patterns were identified: 1 subtype with lacunar lesions distributed in both cerebral hemispheres, and another with lesions predominantly in 1 hemisphere.
Results:
In the LI group, isolated CS was significantly more frequent on the homolateral side than on the contralateral side (odds ratio [OR], 5.5; 95% CI, 1.2 to 23; P=0.03). A significant relationship between the pattern of distribution of the infarctions in only 1 hemisphere and homolateral CS >70% was observed (OR, 4.4; 95% CI, 0.9 to 19; P=0.03). In a multivariate analysis, the following variables were found to predict unilateral multiple LI: left ventricular hypertrophy (OR, 9.1; 95% CI, 2.5 to 33.6) and homolateral CS >75% (OR, 14.4; 95% CI, 2.0 to 99.6).
Conclusions:
The significant incidence of isolated ipsilateral CS in patients with LI located in the carotid territory and the relationship of CS to ipsilateral multiple LI suggest that CS has a very important role in the development of LI.