title: Risk factors and outcome of patients with symptomatic intracranial stenosis presenting with lacunar stroke.
abstract: OBJECTIVE
  We hypothesized that patients with intracranial stenosis with lacunar stroke presentations would face lower risks of recurrent stroke than those with index nonlacunar strokes, and that their recurrent strokes would predominantly be lacunar.
  
  
  METHODS
  We analyzed subjects enrolled with an index stroke into the Warfarin Aspirin Symptomatic Intracranial Disease (WASID) trial. The index stroke was classified as lacunar or nonlacunar. The primary end point was recurrent ischemic stroke. Cox proportional hazard models were generated with stratification for severity of stenosis.
  
  
  RESULTS
  Three hundred forty-seven subjects were enrolled after an index stroke; 38 were lacunar and 309 were nonlacunar. Over a mean follow-up of 1.8 years, there was no significant difference in stroke recurrence between patients whose index stroke was lacunar (7 of 38 [18%]) versus nonlacunar (69 of 309 [22%]; hazard ratio, 0.79; 95% CI, 0.36-1.71). Furthermore, no significant differences were found when groups were stratified by 50% to 69% stenosis (hazard ratio, 0.50; 95% CI, 0.12-2.1) and ≥ 70% stenosis (hazard ratio, 0.87; 95% CI, 0.34-2.2). Of the 7 recurrent strokes in patients whose index stroke was lacunar, all 7 were nonlacunar and 3 were in the territory of the stenotic artery.
  
  
  CONCLUSIONS
  In patients with symptomatic intracranial stenosis, the risk of recurrent stroke was similar in patients who presented with lacunar and nonlacunar strokes, and recurrent strokes in patients presenting with lacunar stroke were typically nonlacunar. These findings suggest that the pathophysiology of these strokes is related to the stenosis rather than small vessel disease. Patients presenting with lacunar strokes should be included in trials investigating secondary prevention for symptomatic intracranial stenosis.
authors.affiliation: Department of Neurology, University of Pennsylvania, Philadelphia, PA 19104, USA.
authors.forename: Amir
authors.initials: A
authors.lastname: Khan
authors.forename: Scott E
authors.initials: SE
authors.lastname: Kasner
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lynn
authors.forename: Marc I
authors.initials: MI
authors.lastname: Chimowitz
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000150:complications* / Q000503:physiopathology*; D002170:Canada; D003251:Constriction, Pathologic / Q000150:complications / Q000503:physiopathology; D005260:Female; D006801:Humans; D015994:Incidence; D020765:Intracranial Arterial Diseases / Q000150:complications* / Q000503:physiopathology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D059409:Stroke, Lacunar / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D014481:United States