The course of patients with lacunar infarcts and a parent arterial lesion: similarities to large artery vs small artery disease.
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.
Bang
Oh Young
OY
Department of Neurology, School of Medicine, Ajou University, Suwon, South Korea. nmboy@unitel.co.kr
Joo
Sung Yeol
SY
Lee
Phil Hyu
PH
Joo
Uk Shik
US
Lee
Jae Hyuk
JH
Joo
In Soo
IS
Huh
Kyoon
K
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