Two types of lacunar infarcts: further arguments from a study on prognosis.
OBJECTIVE
Earlier, we found that lacunar stroke patients with > or =1 asymptomatic lacunar infarcts on CT had leukoaraiosis and hypertension significantly more often than patients without such lesions, and we hypothesized that 2 types of small-vessel disease could be distinguished during life: arteriolosclerosis and microatheromatosis, respectively. Differences in prognosis might sustain this hypothesis of 2 lacunar stroke entities. Therefore, we performed a follow-up in 333 patients with first lacunar stroke, distinguishing those with > or =1 asymptomatic lacunar lesions (LACI+) from those without such lesions (LACI-).


METHODS
Cross-sectional follow-up was performed after 785+/-479 days (mean+/-SD) in 104 LACI+ patients and 865+/-545 days in 229 LACI- patients.


RESULTS
Mortality at the end of follow-up was 33% in LACI+ and 21% in LACI- patients [odds ratio (OR), 1.74; 95% confidence interval (CI), 1.01 to 3.01]. Stroke recurrence rate was 21% in LACI+ and 11% in LACI- (OR, 2.09; 95% CI, 1.08 to 4.06). Forty percent of LACI+ and 26% of LACI- patients had unfavorable outcome at the end of follow-up (OR, 1.95; 95% CI, 1.17 to 3.26). Kaplan-Meier curves showed less favorable survival in LACI+ (log-rank test, P=0.0218) and survival free of stroke (log-rank test, P=0.0121) than in LACI-. When we restricted the analysis to patients with both silent lesions and leukoaraiosis (n=63) compared with those without (n=196), differences were even more pronounced.


CONCLUSIONS
Prognosis for mortality, recurrent stroke, and overall functional outcome in lacunar stroke patients with > or =1 silent lacunar lesions is more unfavorable than in patients without such lesions. These findings sustain the idea of 2 lacunar stroke entities.
de Jong
G
G
Department of Neurology, Isala Clinics Location Weezenlanden, Zwolle, The Netherlands.
Kessels
F
F
Lodder
J
J
D001161:Arteriosclerosis / Q000175:diagnosis / Q000473:pathology; D001921:Brain / Q000098:blood supply / Q000473:pathology; D020520:Brain Infarction / Q000145:classification* / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications; D016015:Logistic Models; D008833:Microcirculation / Q000473:pathology; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome