Are Lacunar Strokes Really Different? A Systematic Review of Differences in Risk Factor Profiles Between Lacunar and Nonlacunar Infarcts

Overview

Journal Stroke

Specialties Cardiology & Vascular Diseases
Neurology

Date 2005 Mar 12

PMID 15761206

Citations 60

Authors

Caroline Jackson

Cathie Sudlow

Affiliations

Soon will be listed here.

Abstract

Background And Purpose: Differences in risk factors between lacunar and nonlacunar infarcts might support a distinct arterial pathological process underlying lacunar infarction.

Methods: We did a systematic review of studies comparing risk factors in patients with lacunar versus nonlacunar infarction. For each risk factor, we calculated study-specific and pooled relative risks (RRs) for lacunar versus nonlacunar infarction.

Results: A total of 16 of 28 studies included risk factors in their ischemic stroke subtype definitions. Hypertension and diabetes appeared commoner among patients with lacunar versus nonlacunar infarction. However, analyses confined to studies using risk factor-free ischemic subtype definitions found only a marginal excess of hypertension with lacunar versus nonlacunar infarction (RR, 1.11; 95% CI, 1.04 to 1.19) and no difference for diabetes (RR, 0.95; 95% CI, 0.83 to 1.09). Atrial fibrillation and carotid stenosis were associated more with nonlacunar than lacunar infarction but less so when only studies using risk factor-free classifications were considered. Otherwise, there was no evidence of differences in risk factor profiles.

Conclusions: Risk factor-free ischemic stroke subtype classification methods should be used for comparing risk factor profiles between lacunar and nonlacunar subtypes.

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References

Falcone R, Shapiro E, Jangula J, Johnson C . Transesophageal echocardiographic findings in subcortical and cortical stroke. Am J Cardiol. 2000; 85(1):121-4, A9. DOI: 10.1016/s0002-9149(99)00623-2. View

Saposnik G, Caplan L, Gonzalez L, Baird A, Dashe J, Luraschi A . Differences in stroke subtypes among natives and caucasians in Boston and Buenos Aires. Stroke. 2000; 31(10):2385-9. DOI: 10.1161/01.str.31.10.2385. View

Nagai Y, Kitagawa K, Sakaguchi M, Shimizu Y, Hashimoto H, Yamagami H . Significance of earlier carotid atherosclerosis for stroke subtypes. Stroke. 2001; 32(8):1780-5. DOI: 10.1161/01.str.32.8.1780. View

Goldstein L, Jones M, Matchar D, Edwards L, Hoff J, Chilukuri V . Improving the reliability of stroke subgroup classification using the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria. Stroke. 2001; 32(5):1091-8. DOI: 10.1161/01.str.32.5.1091. View

Saposnik G, Gonzalez L, Lepera S, Luraschi A, Sica R, Caplan L . Southern Buenos Aires stroke project. Acta Neurol Scand. 2001; 104(3):130-5. DOI: 10.1034/j.1600-0404.2001.00039.x. View

Lee B, Nam H, Heo J, Kim D . Yonsei Stroke Registry. Analysis of 1,000 patients with acute cerebral infarctions. Cerebrovasc Dis. 2001; 12(3):145-51. DOI: 10.1159/000047697. View

Grau A, Weimar C, Buggle F, Heinrich A, Goertler M, Neumaier S . Risk factors, outcome, and treatment in subtypes of ischemic stroke: the German stroke data bank. Stroke. 2001; 32(11):2559-66. DOI: 10.1161/hs1101.098524. View

Kolominsky-Rabas P, Weber M, Gefeller O, Neundoerfer B, Heuschmann P . Epidemiology of ischemic stroke subtypes according to TOAST criteria: incidence, recurrence, and long-term survival in ischemic stroke subtypes: a population-based study. Stroke. 2001; 32(12):2735-40. DOI: 10.1161/hs1201.100209. View

Cupini L, Pasqualetti P, Diomedi M, Vernieri F, Silvestrini M, Rizzato B . Carotid artery intima-media thickness and lacunar versus nonlacunar infarcts. Stroke. 2002; 33(3):689-94. DOI: 10.1161/hs0302.103661. View

10.

Cerrato P, Imperiale D, Priano L, Mangiardi L, Morello M, Marson A . Transoesophageal echocardiography in patients without arterial and major cardiac sources of embolism: difference between stroke subtypes. Cerebrovasc Dis. 2002; 13(3):174-83. DOI: 10.1159/000047772. View

11.

Sumer M, Erturk O . Ischemic stroke subtypes: risk factors, functional outcome and recurrence. Neurol Sci. 2002; 22(6):449-54. DOI: 10.1007/s100720200004. View

12.

Kelly J, Hunt B, Rudd A, Lewis R . Should patients with lacunar stroke and severe carotid artery stenosis undergo endarterectomy?. QJM. 2002; 95(5):313-9. DOI: 10.1093/qjmed/95.5.313. View

13.

Lee T, Hsu W, Chen C, Chen S . Etiologic study of young ischemic stroke in Taiwan. Stroke. 2002; 33(8):1950-5. DOI: 10.1161/01.str.0000021409.16314.16. View

14.

Schulz U, Rothwell P . Differences in vascular risk factors between etiological subtypes of ischemic stroke: importance of population-based studies. Stroke. 2003; 34(8):2050-9. DOI: 10.1161/01.STR.0000079818.08343.8C. View

15.

Fisher C . The arterial lesions underlying lacunes. Acta Neuropathol. 1968; 12(1):1-15. DOI: 10.1007/BF00685305. View

16.

Fisher C . Bilateral occlusion of basilar artery branches. J Neurol Neurosurg Psychiatry. 1977; 40(12):1182-9. PMC: 492941. DOI: 10.1136/jnnp.40.12.1182. View

17.

Mohr J, Caplan L, Melski J, GOLDSTEIN R, Duncan G, Kistler J . The Harvard Cooperative Stroke Registry: a prospective registry. Neurology. 1978; 28(8):754-62. DOI: 10.1212/wnl.28.8.754. View

18.

Fisher C . Thalamic pure sensory stroke: a pathologic study. Neurology. 1978; 28(11):1141-4. DOI: 10.1212/wnl.28.11.1141. View

19.

Fisher C . Capsular infarcts: the underlying vascular lesions. Arch Neurol. 1979; 36(2):65-73. DOI: 10.1001/archneur.1979.00500380035003. View

20.

Pullicino P, Nelson R, Kendall B, Marshall J . Small deep infarcts diagnosed on computed tomography. Neurology. 1980; 30(10):1090-6. DOI: 10.1212/wnl.30.10.1090. View