title: The course of patients with lacunar infarcts and a parent arterial lesion: similarities to large artery vs small artery disease.
abstract: BACKGROUND
  The significance of occlusive lesions of the parent artery in patients with lacunar syndrome (LS) and small deep infarcts (SDIs) on diffusion-weighted imaging remains unclear.
  
  
  OBJECTIVE
  To compare the recurrence of stroke in patients with LS and SDIs between those with vs without a parent arterial lesion.
  
  
  METHODS
  Analysis of data from a prospective acute stroke registry.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Using clinical syndrome, diffusion-weighted imaging, and vascular studies, we divided 173 patients into 3 groups: (1) parent arterial disease occluding deep perforators (PAD), LS with SDIs, and a parent arterial lesion (n = 32); (2) small artery disease (SAD) (n = 70); and (3) large artery disease (LAD) (n = 71).
  
  
  METHODS
  Recurrent strokes and the prognosis were registered for 1 year, and the outcome of the PAD group was compared with that of the SAD and LAD groups.
  
  
  RESULTS
  During follow-up, there were 9 deaths (6 vascular) and 18 recurrent strokes. The recurrence rate in the PAD group (16%) was significantly higher than that in the SAD group (1%) (P =.01) but similar to that in the LAD group (17%) (P =.87). The presence of the parent arterial lesion was the only independent predictor of stroke recurrence in patients with LS and SDIs (odds ratio, 13.8; 95% confidence interval, 1.5-123.9; P =.02).
  
  
  CONCLUSIONS
  Although LS on examination, SDIs on diffusion-weighted imaging, and a stable hospital course suggest lacunar stroke of benign course, our results indicate that the PAD group represents an intracranial type of LAD.
authors.affiliation: Department of Neurology, School of Medicine, Ajou University, Suwon, South Korea. nmboy@unitel.co.kr
authors.forename: Oh Young
authors.initials: OY
authors.lastname: Bang
authors.forename: Sung Yeol
authors.initials: SY
authors.lastname: Joo
authors.forename: Phil Hyu
authors.initials: PH
authors.lastname: Lee
authors.forename: Uk Shik
authors.initials: US
authors.lastname: Joo
authors.forename: Jae Hyuk
authors.initials: JH
authors.lastname: Lee
authors.forename: In Soo
authors.initials: IS
authors.lastname: Joo
authors.forename: Kyoon
authors.initials: K
authors.lastname: Huh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D020520:Brain Infarction / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D002539:Cerebral Arterial Diseases / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging; D004292:Dominance, Cerebral / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate