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Neurology Sep 2014In this cross-sectional study, we tested the construct validity of a "total SVD score," which combines individual MRI features of small-vessel disease (SVD) in one...
OBJECTIVES
In this cross-sectional study, we tested the construct validity of a "total SVD score," which combines individual MRI features of small-vessel disease (SVD) in one measure, by testing associations with vascular risk factors and stroke subtype.
METHODS
We analyzed data from patients with lacunar or nondisabling cortical stroke from 2 prospective stroke studies. Brain MRI was rated for the presence of lacunes, white matter hyperintensities, cerebral microbleeds, and perivascular spaces independently. The presence of each SVD feature was summed in an ordinal "SVD score" (range 0-4). We tested associations with vascular risk factors, stroke subtype, and cerebral atrophy using ordinal regression analysis.
RESULTS
In 461 patients, multivariable analysis found that age (odds ratio [OR] 1.10, 95% confidence interval [CI] 1.08-1.12), male sex (OR 1.58, 95% CI 1.10-2.29), hypertension (OR 1.50, 95% CI 1.02-2.20), smoking (OR 2.81, 95% CI 1.59-3.63), and lacunar stroke subtype (OR 2.45, 95% CI 1.70-3.54) were significantly and independently associated with the total SVD score. The score was not associated with cerebral atrophy.
CONCLUSIONS
The total SVD score may provide a more complete estimate of the full impact of SVD on the brain, in a simple and pragmatic way. It could have potential for patient or risk stratification or early efficacy assessment in clinical trials of interventions to prevent SVD progression and may (after further testing) have a useful role in clinical practice.
Topics: Adult; Aged; Aged, 80 and over; Atrophy; Brain; Brain Ischemia; Cerebral Small Vessel Diseases; Cross-Sectional Studies; Female; Humans; Hypertension; Magnetic Resonance Imaging; Male; Middle Aged; Prospective Studies; Risk Factors; Severity of Illness Index; Sex Factors; Smoking; Stroke; Stroke, Lacunar
PubMed: 25165388
DOI: 10.1212/WNL.0000000000000837 -
Journal of Atherosclerosis and... Jul 2023Intracranial branch atheromatous disease (BAD) is a pathological condition characterized by the occlusion of a relatively large perforating branch (700-800 µm) near the... (Review)
Review
Intracranial branch atheromatous disease (BAD) is a pathological condition characterized by the occlusion of a relatively large perforating branch (700-800 µm) near the orifice of a parent artery due to atherosclerotic plaque-based thrombus (microatheroma). BAD is refractory to treatment and follows a course of progressive exacerbation, especially motor paralysis. Uniform treatment for common atherothrombotic cerebral infarction or lacunar infarction does not prevent the progressive exacerbation of BAD, and consequently affects functional prognosis. To date, various combinations of treatments have been investigated and proposed to attenuate the worsening symptoms of BAD. However, no therapy with established efficacy is yet available for BAD. Since it is the most difficult condition to treat in the area of cerebral infarction, the establishment of optimal treatment methods for BAD is keenly awaited. This review presents an overview of the acute treatments available for BAD and discusses the prospects for optimal treatment.
Topics: Plaque, Atherosclerotic; Humans; Intracranial Thrombosis; Cerebral Infarction; Stroke, Lacunar; Dual Anti-Platelet Therapy
PubMed: 37183021
DOI: 10.5551/jat.RV22003 -
Stroke Sep 2023Previous observational studies reported that a lower serum 25-hydroxyvitamin D [25(OH)D] concentration is associated with a higher burden of cerebral small vessel...
BACKGROUND
Previous observational studies reported that a lower serum 25-hydroxyvitamin D [25(OH)D] concentration is associated with a higher burden of cerebral small vessel disease (cSVD). The causality of this association is uncertain, but it would be clinically important, given that 25(OH)D can be a target for intervention. We tried to examine the causal effect of 25(OH)D concentration on cSVD-related phenotypes using a Mendelian randomization approach.
METHODS
Genetic instruments for each serum 25(OH)D concentration and cSVD-related phenotypes (lacunar stroke, white matter hyperintensity, cerebral microbleeds, and perivascular spaces) were derived from large-scale genome-wide association studies. We performed 2-sample Mendelian randomization analyses with multiple post hoc sensitivity analyses. A bidirectional Mendelian randomization approach was also used to explore the possibility of reverse causation.
RESULTS
We failed to find any significant causal effect of 25(OH)D concentration on cSVD-related phenotypes (odds ratio [95% CI], 1.00 [0.87-1.16], 1.01 [0.96-1.07], 1.06 [0.85-1.33], 1.00 [0.97-1.03], 1.02 [0.99-1.04], 1.01 [0.99-1.04] for lacunar stroke, white matter hyperintensity, cerebral microbleeds, and white matter, basal ganglia, hippocampal perivascular spaces, respectively). These results were reproduced in the sensitivity analyses accounting for genetic pleiotropy. Conversely, when we examined the effects of cSVD phenotypes on 25(OH)D concentration, cerebral microbleeds were negatively associated with 25(OH)D concentration (0.94 [0.92-0.96]).
CONCLUSIONS
Given the adequate statistical power (>0.8) of the analyses, our findings suggest that the previously reported association between 25(OH)D concentration and cSVD phenotypes might not be causal and partly attributed to reverse causation.
Topics: Humans; Stroke, Lacunar; Mendelian Randomization Analysis; Genome-Wide Association Study; Cerebral Small Vessel Diseases; Vitamin D; Cerebral Hemorrhage; Polymorphism, Single Nucleotide
PubMed: 37465996
DOI: 10.1161/STROKEAHA.123.042980 -
Brain Sciences Nov 2021Lacunar stroke (LS) is responsible for one-quarter of the overall number of ischemic strokes with long-term complications and carries health and economic issues for...
Lacunar stroke (LS) is responsible for one-quarter of the overall number of ischemic strokes with long-term complications and carries health and economic issues for patients and health care systems. Therefore, we aimed to investigate lacunar versus non-lacunar strokes in a tertiary academic center. From February 2016 to July 2019, all patients admitted to the stroke unit were retrospectively reviewed. We included LS patients and compared them to other TOAST subtypes. Hemorrhagic stroke and conditions mimicking stroke were excluded. Regression analysis was done to determine LS predictors and outcomes. A 35.5% rate of LS among 989 ischemic stroke patients was found. Most patients (71.9%) were males. Lower National Institutes of Health Stroke Scale (NIHSS) scores at admission and negative history for cardiac diseases were predictors for LS in our population. At discharge, LS patients had low NIHSS scores and shorter hospitalization periods compared to non-LS patients. In conclusion, LS was prevalent among ischemic stroke patients in our cohort. Future studies are highly needed with long follow-up intervals to identify the stroke recurrence, complications, and outcomes.
PubMed: 34827465
DOI: 10.3390/brainsci11111466 -
Journal of Stroke and Cerebrovascular... Aug 2019Since the term "lacune" was adopted in the 1800s to describe infarctions from cerebral small vessels, their underlying pathophysiological basis remained obscure until... (Review)
Review
Since the term "lacune" was adopted in the 1800s to describe infarctions from cerebral small vessels, their underlying pathophysiological basis remained obscure until the 1960s when Charles Miller Fisher performed several autopsy studies of stroke patients. He observed that the vessels displayed segmental arteriolar disorganization that was associated with vessel enlargement, hemorrhage, and fibrinoid deposition. He coined the term "lipohyalinosis" to describe the microvascular mechanism that engenders small subcortical infarcts in the absence of a compelling embolic source. Since Fisher's early descriptions of lipohyalinosis and lacunar stroke (LS), there have been many advancements in the understanding of this disease process. Herein, we review lipohyalinosis as it relates to modern concepts of cerebral small vessel disease (cSVD). We discuss clinical classifications of LS as well as radiographic definitions based on modern neuroimaging techniques. We provide a broad and comprehensive overview of LS pathophysiology both at the vessel and parenchymal levels. We also comment on the role of biomarkers, the possibility of systemic disease processes, and advancements in the genetics of cSVD. Lastly, we assess preclinical models that can aid in studying LS disease pathogenesis. Enhanced understanding of this highly prevalent disease will allow for the identification of novel therapeutic targets capable of mitigating disease sequelae.
Topics: Animals; Biomarkers; Biopsy; Brain; Cerebral Arteries; Cerebrovascular Circulation; Genetic Predisposition to Disease; History, 19th Century; History, 20th Century; History, 21st Century; Humans; Neuroimaging; Phenotype; Predictive Value of Tests; Prognosis; Risk Factors; Stroke, Lacunar; Vascular Remodeling
PubMed: 31151839
DOI: 10.1016/j.jstrokecerebrovasdis.2019.05.006 -
Journal of Stroke Jan 2014Stroke is a major health burden in Thailand. It is the leading cause of death and long term disability in both men and women. Despite the improvement of healthcare... (Review)
Review
Stroke is a major health burden in Thailand. It is the leading cause of death and long term disability in both men and women. Despite the improvement of healthcare system, the mortality rate of stroke is still increasing during the past 5 years. The incidence of stroke in Thailand is now being studied in a large population based cohort. The prevalence of stroke is estimated to be 1.88% among adults 45 years and older. Stroke is more prevalent in men than in women and the mean age of stroke onset is 65 years. Hypertension, diabetes, dyslipidemia, metabolic syndrome, and atrial fibrillation are major risk factors of stroke in the Thai population. Evolution from predominantly rural to urbanized industrial communities result in the increasing prevalence of these risk factors. Similar to other parts of the world, ischemic stroke is the most common stroke type but the proportion of hemorrhagic stroke is higher when compared to Caucasian populations. Among patients with ischemic stroke, lacunar stroke is most common, accounting for almost half followed by atherosclerotic disease. Intracranial atherosclerosis is also prevalent in Thai population. For acute treatment, intravenous thrombolysis has been used in Thailand for over 20 years. Its cost is reimbursed by the national health care system but its use is still limited. With the introduction of the stroke fast track system, prompt stroke treatment across the country is warranted. Stroke unit is now the standard of care in large regional and provincial hospitals.
PubMed: 24741559
DOI: 10.5853/jos.2014.16.1.1 -
Clinical Interventions in Aging 2015Cerebral small vessel disease (CSVD) is a group of pathological processes with multifarious etiology and pathogenesis that are involved into the small arteries,... (Review)
Review
Cerebral small vessel disease (CSVD) is a group of pathological processes with multifarious etiology and pathogenesis that are involved into the small arteries, arterioles, venules, and capillaries of the brain. CSVD mainly contains lacunar infarct or lacunar stroke, leukoaraiosis, Binswanger's disease, and cerebral microbleeds. CSVD is an important cerebral microvascular pathogenesis as it is the cause of 20% of strokes worldwide and the most common cause of cognitive impairment and dementia, including vascular dementia and Alzheimer's disease (AD). It has been well identified that CSVD contributes to the occurrence of AD. It seems that the treatment and prevention for cerebrovascular diseases with statins have such a role in the same function for AD. So far, there is no strong evidence-based medicine to support the idea, although increasing basic studies supported the fact that the treatment and prevention for cerebrovascular diseases will benefit AD. Furthermore, there is still lack of evidence in clinical application involved in specific drugs to benefit both AD and CSVD.
Topics: Aging; Alzheimer Disease; Atrophy; Brain; Cerebral Small Vessel Diseases; Cognition Disorders; Dementia; Dementia, Vascular; Humans; LDL-Receptor Related Proteins; Leukoaraiosis; Membrane Transport Proteins; Polymorphism, Single Nucleotide; Risk Factors; Stroke, Lacunar
PubMed: 26604717
DOI: 10.2147/CIA.S90871 -
Cerebrovascular Diseases (Basel,... 2021Patients with poststroke cognitive impairment appear to be at higher risk of recurrent stroke and death. However, whether cognitive impairment after lacunar stroke is...
INTRODUCTION
Patients with poststroke cognitive impairment appear to be at higher risk of recurrent stroke and death. However, whether cognitive impairment after lacunar stroke is associated with recurrent stroke and death remains unclear. We assessed whether global or domain-specific cognitive impairment after lacunar stroke is associated with recurrent stroke and death.
METHODS
We considered patients from the Secondary Prevention of Small Subcortical Strokes (SPS3) trial with a baseline cognitive exam administered in English by certified SPS3 personnel, 14-180 days after qualifying lacunar stroke. We considered a baseline score of ≤86 on the Cognitive Assessment Screening Instrument to indicate global cognitive impairment, <10 on the Clock Drawing on Command test to indicate executive function impairment, and domain-specific summary scores in the lowest quartile to indicate memory and nonmemory impairment. We used Cox proportional hazards models to estimate the association between poststroke cognitive impairment and subsequent risk of recurrent stroke and death.
RESULTS
The study included 1,528 participants with a median enrollment time of 62 days after qualifying stroke. During a mean follow-up of 3.9 years, 11.4% of participants had recurrent stroke and 8.2% died. In the fully adjusted models, memory impairment was independently associated with an increased risk of recurrent stroke (hazard ratio, 1.48; 95% confidence interval [95% CI]: 1.04-2.09) and death (hazard ratio, 1.87; 95% CI: 1.25-2.79). Global impairment (hazard ratio, 1.66; 95% CI: 1.06-2.59) and nonmemory impairment (hazard ratio, 1.74; 95% CI: 1.14-2.67) were associated with an increased risk of death.
DISCUSSION/CONCLUSION
After lacunar stroke, memory impairment was an independent predictor of recurrent stroke and death, while global and nonmemory impairment were associated with death. Cognitive screening in lacunar stroke may help identify populations at higher risk of recurrent stroke and death.
Topics: Aged; Cause of Death; Cognition; Cognitive Dysfunction; Female; Humans; Male; Memory; Memory Disorders; Middle Aged; Neuropsychological Tests; Predictive Value of Tests; Prognosis; Randomized Controlled Trials as Topic; Recurrence; Risk Assessment; Risk Factors; Stroke, Lacunar; Time Factors
PubMed: 33752211
DOI: 10.1159/000514261 -
BMJ Open Dec 2022To report the prevalence and distribution of lacunar stroke in different regions of China, as well as the demographical characteristics of symptomatic and asymptomatic...
OBJECTIVES
To report the prevalence and distribution of lacunar stroke in different regions of China, as well as the demographical characteristics of symptomatic and asymptomatic lacunar stroke.
DESIGN
Cross-sectional study.
SETTING
Data were derived from NESS-China Study that was conducted in 157 sites covering all 31 provinces, including 64 urban and 93 rural areas in mainland China between 1 September 2013 and 31 December 2013. Lacunar stroke was defined as being previously diagnosed according to the participants' medical history. Patients were further divided into symptomatic or asymptomatic groups, depending on whether they were initially diagnosed with neurological symptoms.
PARTICIPANTS
458 833 participants aged ≥20 years were enrolled in this study.
RESULTS
A total of 7520 participants (1.63%) were diagnosed with lacunar stroke. The peak rate of diagnosis was between the ages of 70 and 79 years in both men and women. Geographically, the age-standardised and sex-standardised prevalence was highest in Northeast China (2495.3/100 000 persons) and lowest in Southeast China (599.7/100 000 persons), showing a geographical disparity. Over 90% of patients with lacunar stroke were diagnosed in secondary or tertiary hospitals. Patients with symptomatic lacunar stroke had significantly different demographic characteristics in age, sex and geographical regions compared with those who were asymptomatic.
CONCLUSIONS
In this study, the prevalence and distribution of lacunar stroke were reported at population level across China. Special attention and prevention should be given to the age, sex and geographical groups that are vulnerable to lacunar stroke.
Topics: Male; Humans; Female; Aged; Stroke, Lacunar; Cross-Sectional Studies; Self Report; Prevalence; China; Stroke; Risk Factors
PubMed: 36585136
DOI: 10.1136/bmjopen-2022-063520 -
Frontiers in Neurology 2021This study aimed to examine the association of polyvascular disease and clinical outcomes in patients with lacunar stroke. Data of patients with recent lacunar stroke...
This study aimed to examine the association of polyvascular disease and clinical outcomes in patients with lacunar stroke. Data of patients with recent lacunar stroke were collected from The Third China National Stroke Registry. Polyvascular disease is defined as the existence of atherosclerosis across two or more vascular beds. For the present study, polyvascular disease patients were grouped as follows: coronary heart disease (CHD) and lacunar stroke, peripheral arterial disease (PAD) and lacunar stroke, and CHD/PAD and lacunar stroke. The major clinical outcome was recurrence, and the secondary clinical outcome was major adverse cardiovascular events (MACEs). A Cox proportional multivariable hazards regression model was applied to estimate the association between polyvascular disease and outcomes. Among 3,165 patients with recent lacunar stroke, CHD was present in 375 (11.8%) and peripheral arterial disease in 168 (5.3%). The hazard ratio (HR) for stroke recurrence was 0.98 (95% confidence interval [CI], 0.65-1.46; = 0.91) for patients with CHD and lacunar stroke, 1.07 (95% CI, 0.61-1.87; = 0.82) for patients with PAD and lacunar stroke, and 0.95 (95% CI, 0.66-1.35; = 0.75) for patients with CHD/PAD and lacunar stroke compared with patients with isolated lacunar stroke. The HR for MACEs was 1.01 (95% CI, 0.69-1.49; = 0.94) for patients with CHD and lacunar stroke, 1.11 (95% CI, 0.65-1.90; = 0.71) for patients with PAD and lacunar stroke, and 0.99 (95% CI, 0.70-1.40; = 0.95) for patients with CHD/PAD and lacunar stroke. Polyvascular disease is not associated with recurrence of stroke and MACEs in patients with recent lacunar stroke at 1 year.
PubMed: 34566851
DOI: 10.3389/fneur.2021.706991