Clinical characteristics and outcome of patients with lacunar infarcts and concurrent embolic ischemic lesions

Barow, E. et al. (2020) Clinical characteristics and outcome of patients with lacunar infarcts and concurrent embolic ischemic lesions. Clinical Neuroradiology, 30, pp. 511-516. (doi: 10.1007/s00062-019-00800-5) (PMID:1161343)

Abstract

Purpose: Lacunar infarcts are thought to result from occlusion of small penetrating arteries due to microatheroma and lipohyalinosis, pathognomonic for cerebral small vessel disease (CSVD). Concurrent embolic ischemic lesions indicate a different stroke mechanism. The purpose of this study was to examine the clinical characteristics and outcome of patients with lacunar infarcts and concurrent embolic infarcts on diffusion-weighted imaging (DWI). Methods: All patients screened for the WAKE-UP trial (ClinicalTrials.gov number, NCT01525290) were reviewed for acute lacunar infarcts and concurrent embolic lesions on baseline DWI. Clinical characteristics and outcome were compared between lacunar infarct patients with and without concurrent embolic lesions. Results: Of 244 patients with an acute lacunar infarct, 20 (8.2%) had concurrent acute embolic infarcts. Compared to patients with a lacunar infarct only, patients with concurrent embolic infarcts were older (mean age 69 years vs. 63 years; p = 0.031), more severely affected (median National Institutes of Health Stroke Scale [NIHSS] score 5 vs. 4; p = 0.046), and—among those randomized—had worse functional outcome at 90 days (median modified Rankin Scale [mRS] 3 vs. 1; p = 0.011). Conclusion: Approximately 8% of lacunar infarct patients show concurrent embolic lesions suggesting a stroke etiology other than CSVD. These patients are more severely affected and have a worse functional outcome illustrating the need for a thorough diagnostic work-up of possible embolic sources even in patients with an imaging-defined diagnosis of lacunar infarcts.

• Item Type: Articles
• Additional Information: WAKE-UP received funding from the European Union Seventh Framework Program [FP7/2007-2013] under grant agreement n°278276 (WAKE-UP).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Muir, Professor Keith and Ford, Professor Ian
• Authors: Barow, E., Boutitie, F., Cheng, B., Cho, T.-H., Ebinger, M., Endres, M., Fiebach, J. B., Fiehler, J., Ford, I., Galinovic, I., Nickel, A., Puig, J., Roy, P., Wouters, A., Thijs, V., Lemmens, R., Muir, K. W., Nighoghossian, N., Pedraza, S., Simonsen, C. Z., Gerloff, C., and Thomalla, G.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre; College of Medical Veterinary and Life Sciences > School of Psychology & Neuroscience
• Journal Name: Clinical Neuroradiology
• Publisher: Springer
• ISSN: 1869-1439
• ISSN (Online): 1869-1447
• Published Online: 03 June 2019
• Copyright Holders: Copyright © 2019 Springer-Verlag GmbH Germany
• First Published: First published in Clinical Neuroradiology 30:511-516
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher