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Clinical and radiologic features of lacunar versus nonlacunar minor stroke
1Department of Neurology, University Hospital, Lund, Sweden.
Insights
Minor stroke patients with nonlacunar infarcts showed significantly more severe carotid artery disease than those with lacunar infarcts. This highlights the importance of classifying stroke mechanisms for future treatment studies.
Area of Science:
- Neurology
- Vascular Medicine
- Radiology
Background:
- Minor ischemic strokes within the carotid territory are common.
- Understanding the underlying arterial disease is crucial for effective treatment strategies.
- Distinguishing between different stroke subtypes, such as lacunar and nonlacunar infarcts, may reveal different etiological factors.
Purpose of the Study:
- To investigate the association between extracerebral and intracerebral arterial disease and stroke classification in minor stroke patients.
- To compare the prevalence of severe carotid bifurcation disease in lacunar versus nonlacunar infarcts.
- To emphasize the need for mechanism-based classification in future stroke research.
Main Methods:
- Angiographic assessment of arterial disease in 122 minor stroke patients.
- Exclusion of patients with a cardiac source of emboli.
- Classification of infarcts into lacunar (n=61), nonlacunar (n=53), and indeterminate (n=8) based on clinical and CT findings.
Main Results:
- Severe carotid bifurcation disease (≥50% stenosis or occlusion) was significantly more prevalent in nonlacunar infarcts compared to lacunar infarcts (ipsilateral: p<0.001, contralateral: p<0.01).
- 79% of nonlacunar infarct patients had severe ipsilateral carotid bifurcation and/or middle cerebral artery disease, versus 3.3% of lacunar infarct patients.
- A strong correlation was observed between nonlacunar infarcts and significant ipsilateral carotid and middle cerebral artery disease.
Conclusions:
- Nonlacunar infarcts in minor stroke are strongly associated with severe ipsilateral carotid and middle cerebral artery disease.
- Lacunar infarcts appear to have a different underlying pathophysiology, less related to large artery atherosclerosis.
- Stratifying stroke patients by underlying etiological mechanisms is essential for advancing treatment research and improving patient outcomes.
Abstract:
We determined the angiographic presence of extracerebral and intracerebral arterial disease in 122 patients with minor stroke within the carotid territory; we excluded patients with a recognized cardiac source of emboli. Based on clinical features and computed tomographic findings, patients were classified as having lacunar infarcts (n = 61), nonlacunar infarcts (n = 53), and infarcts of indeterminate type (n = 8). Severe carotid bifurcation disease (greater than or equal to 50% stenosis or occlusion) was significantly more common in nonlacunar than in lacunar infarcts, on both the ipsilateral (p less than 0.001) and the contralateral (p less than 0.01) sides; 79% of the patients with nonlacunar infarcts had severe carotid bifurcation and/or middle cerebral artery disease on the ipsilateral side compared with 3.3% of the patients with lacunar infarcts. Our data underscore the need for classification of patients by the underlying mechanisms in future studies of treatment of ischemic stroke.