title: Cerebral and extracerebral vasoreactivity in symptomatic lacunar stroke patients: a case-control study.
abstract: BACKGROUND
  Whether cerebral artery endothelial dysfunction is a key factor of symptomatic lacunar stroke and cerebral small vessel disease remains unclear.
  
  
  METHODS
  Cerebral and extracerebral vasoreactivity were measured in 81 patients with recent symptomatic lacunar stroke and in 81 control subjects matched for main vascular risk factors. Cerebral vasoreactivity and carotid endothelial-dependent vasodilation were measured after five-minutes of carbon dioxide-induced hypercapnia. Brachial endothelial-dependent vasodilation was assessed after hyperemia induced by deflating a cuff around the forearm previously inflated to 200 mmHg for four-minutes. Carotid and brachial endothelial-independent vasodilation were measured five-minutes after administration of sublingual nitroglycerin 300 μg. Brain magnetic resonance imaging were analyzed in lacunar stroke patients.
  
  
  RESULTS
  One-month after stroke onset, patients had more severely impaired cerebral vasoreactivitys than matched controls (mean ± standard deviation, 14·4 ± 12·1% vs. 19·4 ± 17·4%; P = 0·049). Severe alterations of both carotid and brachial endothelial-dependent and at a lesser degree of carotid and brachial endothelial-independent vasodilation were observed in both groups. After adjustment for confounders, subjects with a cerebral vasoreactivity value in the two lower tertiles (≤19·6%) were more likely to have had a symptomatic lacunar stroke (adjusted odds ratio, 3·78; 95% confidence interval, 1·42 to 10·08; P = 0·008). Only alteration of brachial endothelial-independent vasodilation correlated with parenchymal abnormalities, namely microbleeds and leukoaraiosis.
  
  
  CONCLUSIONS
  While abnormalities in extracerebral vasoreactivity seem related to vascular risk factors, the severity of endothelial dysfunction in cerebral arteries may be determinant in the occurrence of symptomatic lacunar stroke in patients with small vessel disease.
authors.affiliation: INSERM U-698 and Paris-Diderot University, Department of Neurology and Stroke Center, Bichat University Hospital, Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Deplanque
authors.forename: Philippa C
authors.initials: PC
authors.lastname: Lavallee
authors.forename: Julien
authors.initials: J
authors.lastname: Labreuche
authors.forename: Fernando
authors.initials: F
authors.lastname: Gongora-Rivera
authors.forename: Arturo
authors.initials: A
authors.lastname: Jaramillo
authors.forename: David
authors.initials: D
authors.lastname: Brenner
authors.forename: Halim
authors.initials: H
authors.lastname: Abboud
authors.forename: Isabelle F
authors.initials: IF
authors.lastname: Klein
authors.forename: Pierre-Jean
authors.initials: PJ
authors.lastname: Touboul
authors.forename: Eric
authors.initials: E
authors.lastname: Vicaut
authors.forename: Pierre
authors.initials: P
authors.lastname: Amarenco
mesh_terms: D001916:Brachial Artery / Q000503:physiopathology*; D016022:Case-Control Studies; D002536:Cerebral Arteries / Q000503:physiopathology*; D002560:Cerebrovascular Circulation / Q000502:physiology; D004730:Endothelium, Vascular / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059409:Stroke, Lacunar / Q000503:physiopathology*; D014664:Vasodilation