Endothelial dysfunction in lacunar stroke: a systematic review.
BACKGROUND
Endothelial dysfunction is thought to play an important role in the pathogenesis and progression of cerebral small-vessel disease in lacunar stroke patients.


METHODS
We systematically searched the literature (MEDLINE, EMBASE) for evidence of endothelial activation and dysfunction in lacunar stroke. The selected papers were assessed by a predefined checklist to estimate methodological and informative quality. The papers were categorized into subheadings concerning the different physiologic functions of the endothelium and a subheading concerning toxins for the endothelium.


RESULTS
29 articles were eligible for further analysis. We found 16 publications on regulation of vascular tone by the endothelium, which showed an impaired function at several time points after the stroke by means of different clinical methods (e.g. flow-mediated vasodilatation and CO2 reactivity). Nine references showed elevated levels of markers of hemostatic function of the vascular endothelium (e.g. von Willebrand factor, thrombomodulin) in acute and subsequent phases. In 4 papers, adhesion molecules (e.g. E- and P-selectin) were elevated only during the acute phase. Homocysteine, a toxin for the endothelium, was elevated in patients in 3 papers.


CONCLUSIONS
The current literature suggests that endothelial dysfunction might be involved in the pathogenesis of lacunar stroke, especially in those patients with concomitant silent lacunar infarcts and ischemic white matter lesions. Future research on endothelial function in lacunar stroke should concentrate on long-term clinical as well as radiological follow-up in well-defined cases and combine multiple methods to evaluate endothelial function.
Knottnerus
Iris L H
IL
Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands. iris.knottnerus@neurologie.azm.nl
Ten Cate
Hugo
H
Lodder
Jan
J
Kessels
Fons
F
van Oostenbrugge
Robert J
RJ
D020520:Brain Infarction / Q000503:physiopathology*; D004730:Endothelium, Vascular / Q000503:physiopathology*; D006487:Hemostasis / Q000502:physiology; D006710:Homocysteine / Q000502:physiology; D006801:Humans; D020521:Stroke / Q000503:physiopathology*; D014664:Vasodilation / Q000502:physiology
D006710:Homocysteine