Need for extensive diagnostic work-up for patients with lacunar stroke

Area of Science:

• Neurology
• Vascular Neurology
• Stroke Medicine

Background:

• Small-vessel disease is the predominant cause of lacunar stroke.
• Identifying alternative etiologies is critical for understanding stroke outcomes.

Purpose of the Study:

• To investigate alternative causes of lacunar stroke beyond small-vessel disease.
• To compare the functional outcomes of lacunar strokes attributed to small-vessel disease versus other causes.

Main Methods:

• Prospective follow-up of consecutive patients with first-ever ischemic lacunar stroke for at least 3 months.
• Patients were categorized into lacunar stroke due to small vessel disease (L-SVD) and lacunar stroke due to other etiologies (L-non SVD).
• Outcomes assessed included death, disability (modified Rankin Scale score ≥3), and recurrent stroke.

Main Results:

• Of 196 lacunar stroke patients, 72.4% had L-SVD and 27.6% had L-non SVD.
• Patients with L-non SVD experienced higher rates of death or disability (49% vs. 34.7%) and stroke recurrence (20.4% vs. 11.3%).
• L-non SVD was an independent predictor of worse outcomes, including recurrence (OR=5.03).

Conclusions:

• Approximately 27% of lacunar strokes stem from causes other than small-vessel disease.
• These alternative causes are associated with significantly poorer functional outcomes, including increased mortality, disability, and stroke recurrence.
• A thorough diagnostic evaluation is essential for all patients presenting with lacunar stroke to identify non-small-vessel disease etiologies.