title: Vascular retinal, neuroimaging and ultrasonographic markers of lacunar infarcts.
abstract: BACKGROUND
  Lacunar infarcts may be caused by macro- or microvascular disease due to several mechanisms.
  
  
  OBJECTIVE
  This study aims to demonstrate that retinal vascular disturbances in patients with lacunar infarcts associated with neuroimaging and ultrasound markers can help to identify small-vessel disease.
  
  
  METHODS
  Prospective ambulatory study of patients with ischaemic stroke and a control group. A retinographic study was performed by 20° bilateral optic disc stereophotography and 50° bilateral optic fundus retinography. Microangiopathy was evaluated as the presence of nonparenchymal vascular affectation and retinopathy as at least one retinal disturbance. Ultrasonographic study evaluated carotid disorder parameters and the mean pulsatility index. The MRI protocol included T1-weighted, T2-weighted, DP-weighted and FLAIR.
  
  
  RESULTS
  We included 156 nonlacunar infarcts, 39 lacunar infarcts and 50 controls. Microangiopathy was more frequent in hypertensive (62·6% vs. 35·7%, P<0·0001) and vascular retinopathy in diabetic patients (11·7% vs. 3·8%, P=0·039). Microangiopathy (97·4% vs. 41·1%, P<0·0001) and leukoaraiosis (94·4% vs. 50·3%, P<0·0001) were more frequent and the mean pulsatility index was higher (1·9 ± 0·2 vs. 1·4 ± 0·5, P<0·0001) in patients with lacunar infarcts. Lacunar infarcts were independently associated with microangiopathy (odds ratio 12·81, 95% CI 1·52-107·86), the mean pulsatility index (odds ratio 8·13, 95% CI 1·17-56·20) and leukoaraiosis (odds ratio 3·45, 95% CI 1·09-10·93). The presence of leukoaraiosis plus microangiopathy was associated with lacunar infarcts with odds ratio 21·31 (95% CI 8·74-51·93).
  
  
  CONCLUSIONS
  The association of retinal microangiopathy (but not vascular retinopathy) and leukoaraiosis is linked to small-vessel disease and may be a useful marker of lacunar infarcts not secondary to a macrovascular lesion.
authors.affiliation: Department of Neurology - Stroke Unit, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Galicia, Spain.
authors.forename: Iria
authors.initials: I
authors.lastname: Rodríguez
authors.forename: Isabel
authors.initials: I
authors.lastname: Lema
authors.forename: Miguel
authors.initials: M
authors.lastname: Blanco
authors.forename: Manuel
authors.initials: M
authors.lastname: Rodríguez-Yáñez
authors.forename: Rogelio
authors.initials: R
authors.lastname: Leira
authors.forename: José
authors.initials: J
authors.lastname: Castillo
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D049292:Leukoaraiosis / Q000150:complications; D008279:Magnetic Resonance Imaging; D008297:Male; D012164:Retinal Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D012171:Retinal Vessels / Q000000981:diagnostic imaging / Q000473:pathology*; D020521:Stroke / Q000150:complications*; D014463:Ultrasonography