Tags

Type your tag names separated by a space and hit enter

Association of lacunar infarcts with small artery and large artery disease: a comparative study.
Acta Neurol Scand. 2004 Dec; 110(6):350-4.AN

Abstract

OBJECTIVES

Patients with lacunar infarcts (LI) and ipsilateral large artery disease (LAD) greater than 50% must be classified according to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria as strokes of undetermined etiology. The purpose of this study was to compare the vascular risk factors, clinical symptoms, and outcome characteristics of LI associated with LAD with those patients with LI who fulfilled the TOAST criteria of small artery disease (SAD).

METHODS

Among 1754 consecutive first ever stroke patients admitted to our department, we analyzed age, gender, vascular risk factors (hypertension, diabetes, ischemic heart disease, arterial peripheral disease, hypercholesterolemia, smoking, alcohol, or illicit drug use), clinical data (motor or sensitive deficit and presence of dysarthria), and outcome (hospitalization length, in-hospital medical complications rate, need of rehabilitation, treatment at discharge, in-hospital mortality, and modified Rankin Scale at discharge) of those patients classified as LI associated with LAD as compared with those with SAD.

RESULTS

After a strict application of the TOAST criteria, we found 144 patients with LI associated with SAD and 73 patients with LI associated with LAD. Univariate analysis showed statistical differences in gender (OR: 0.46; 95% CI: 0.23-0.89; P = 0.014), past history of ischemic heart disease (OR: 0.32; 95% CI: 0.13-0.78; P = 0.004), and smoking (OR: 0.56; 95% CI: 0.31-1.04; P = 0.048). After logistic regression analysis only ischemic heart disease (OR: 0.31; 95% CI: 0.11-0.78; P = 0.013), and gender (OR: 0.51; 95% CI: 0.28-0.98; P = 0.05) showed statistical differences. During the follow-up, six patients (all with LI associated with LAD) experienced stroke recurrences (OR: 0.32; 95% CI: 0.26-0.39; P < 0.001).

CONCLUSIONS

1) There are no differences in clinical presentation and in-hospital outcome between patients with LI associated with SAD and patients with LI associated with LAD. 2) Risk factors are very similar in both groups, and the only differences observed (gender and ischemic heart disease) are related to the atherosclerotic factor. 3) Stroke recurrence seems to be more frequent in LI associated with LAD than in LI associated with SAD, but large follow-up studies are needed to be able to decide whether clinical recurrence of stroke allows to differentiate both clinical entities.

Authors+Show Affiliations

Unitat de Malalties Vasculars Cerebrals, Servei de Neurología, Hospital del Mar, Barcelona, Spain. 35826@imas.imim.esNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

15527446

Citation

Roquer, J, et al. "Association of Lacunar Infarcts With Small Artery and Large Artery Disease: a Comparative Study." Acta Neurologica Scandinavica, vol. 110, no. 6, 2004, pp. 350-4.
Roquer J, Campello AR, Gomis M. Association of lacunar infarcts with small artery and large artery disease: a comparative study. Acta Neurol Scand. 2004;110(6):350-4.
Roquer, J., Campello, A. R., & Gomis, M. (2004). Association of lacunar infarcts with small artery and large artery disease: a comparative study. Acta Neurologica Scandinavica, 110(6), 350-4.
Roquer J, Campello AR, Gomis M. Association of Lacunar Infarcts With Small Artery and Large Artery Disease: a Comparative Study. Acta Neurol Scand. 2004;110(6):350-4. PubMed PMID: 15527446.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of lacunar infarcts with small artery and large artery disease: a comparative study. AU - Roquer,J, AU - Campello,A Rodríguez, AU - Gomis,M, PY - 2004/11/6/pubmed PY - 2004/12/23/medline PY - 2004/11/6/entrez SP - 350 EP - 4 JF - Acta neurologica Scandinavica JO - Acta Neurol Scand VL - 110 IS - 6 N2 - OBJECTIVES: Patients with lacunar infarcts (LI) and ipsilateral large artery disease (LAD) greater than 50% must be classified according to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria as strokes of undetermined etiology. The purpose of this study was to compare the vascular risk factors, clinical symptoms, and outcome characteristics of LI associated with LAD with those patients with LI who fulfilled the TOAST criteria of small artery disease (SAD). METHODS: Among 1754 consecutive first ever stroke patients admitted to our department, we analyzed age, gender, vascular risk factors (hypertension, diabetes, ischemic heart disease, arterial peripheral disease, hypercholesterolemia, smoking, alcohol, or illicit drug use), clinical data (motor or sensitive deficit and presence of dysarthria), and outcome (hospitalization length, in-hospital medical complications rate, need of rehabilitation, treatment at discharge, in-hospital mortality, and modified Rankin Scale at discharge) of those patients classified as LI associated with LAD as compared with those with SAD. RESULTS: After a strict application of the TOAST criteria, we found 144 patients with LI associated with SAD and 73 patients with LI associated with LAD. Univariate analysis showed statistical differences in gender (OR: 0.46; 95% CI: 0.23-0.89; P = 0.014), past history of ischemic heart disease (OR: 0.32; 95% CI: 0.13-0.78; P = 0.004), and smoking (OR: 0.56; 95% CI: 0.31-1.04; P = 0.048). After logistic regression analysis only ischemic heart disease (OR: 0.31; 95% CI: 0.11-0.78; P = 0.013), and gender (OR: 0.51; 95% CI: 0.28-0.98; P = 0.05) showed statistical differences. During the follow-up, six patients (all with LI associated with LAD) experienced stroke recurrences (OR: 0.32; 95% CI: 0.26-0.39; P < 0.001). CONCLUSIONS: 1) There are no differences in clinical presentation and in-hospital outcome between patients with LI associated with SAD and patients with LI associated with LAD. 2) Risk factors are very similar in both groups, and the only differences observed (gender and ischemic heart disease) are related to the atherosclerotic factor. 3) Stroke recurrence seems to be more frequent in LI associated with LAD than in LI associated with SAD, but large follow-up studies are needed to be able to decide whether clinical recurrence of stroke allows to differentiate both clinical entities. SN - 0001-6314 UR - https://www.unboundmedicine.com/medline/citation/15527446/Association_of_lacunar_infarcts_with_small_artery_and_large_artery_disease:_a_comparative_study_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&amp;sid=nlm:pubmed&amp;issn=0001-6314&amp;date=2004&amp;volume=110&amp;issue=6&amp;spage=350 DB - PRIME DP - Unbound Medicine ER -