Clinical Characteristics and Outcome of Patients with Lacunar Infarcts and Concurrent Embolic Ischemic Lesions

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Clinical Characteristics and Outcome of Patients with Lacunar Infarcts and Concurrent Embolic Ischemic Lesions. / WAKE-UP investigators.

I: Clinical neuroradiology, Bind 30, Nr. 3, 09.2020, s. 511-516.

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

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WAKE-UP investigators. / Clinical Characteristics and Outcome of Patients with Lacunar Infarcts and Concurrent Embolic Ischemic Lesions. I: Clinical neuroradiology. 2020 ; Bind 30, Nr. 3. s. 511-516.

Bibtex

@article{be9aa648aee34ae78513bf4622bb4151,
title = "Clinical Characteristics and Outcome of Patients with Lacunar Infarcts and Concurrent Embolic Ischemic Lesions",
abstract = "PURPOSE: Lacunar infarcts are thought to result from occlusion of small penetrating arteries due to microatheroma and lipohyalinosis, pathognomonic for cerebral small vessel disease (CSVD). Concurrent embolic ischemic lesions indicate a different stroke mechanism. The purpose of this study was to examine the clinical characteristics and outcome of patients with lacunar infarcts and concurrent embolic infarcts on diffusion-weighted imaging (DWI).METHODS: All patients screened for the WAKE-UP trial (ClinicalTrials.gov number, NCT01525290) were reviewed for acute lacunar infarcts and concurrent embolic lesions on baseline DWI. Clinical characteristics and outcome were compared between lacunar infarct patients with and without concurrent embolic lesions.RESULTS: Of 244 patients with an acute lacunar infarct, 20 (8.2%) had concurrent acute embolic infarcts. Compared to patients with a lacunar infarct only, patients with concurrent embolic infarcts were older (mean age 69 years vs. 63 years; p = 0.031), more severely affected (median National Institutes of Health Stroke Scale [NIHSS] score 5 vs. 4; p = 0.046), and-among those randomized-had worse functional outcome at 90 days (median modified Rankin Scale [mRS] 3 vs. 1; p = 0.011).CONCLUSION: Approximately 8% of lacunar infarct patients show concurrent embolic lesions suggesting a stroke etiology other than CSVD. These patients are more severely affected and have a worse functional outcome illustrating the need for a thorough diagnostic work-up of possible embolic sources even in patients with an imaging-defined diagnosis of lacunar infarcts.",
keywords = "Embolic stroke, Lacunar infarct, MRI, Stroke etiology, WAKE-UP",
author = "Ewgenia Barow and Florent Boutitie and Bastian Cheng and Tae-Hee Cho and Martin Ebinger and Matthias Endres and Fiebach, {Jochen B} and Jens Fiehler and Ian Ford and Ivana Galinovic and Alina Nickel and Josep Puig and Pascal Roy and Anke Wouters and Vincent Thijs and Robin Lemmens and Muir, {Keith W} and Norbert Nighoghossian and Salvador Pedraza and Simonsen, {Claus Z} and Christian Gerloff and G{\"o}tz Thomalla and {WAKE-UP investigators}",
year = "2020",
month = sep,
doi = "10.1007/s00062-019-00800-5",
language = "English",
volume = "30",
pages = "511--516",
journal = "Clinical neuroradiology",
issn = "1869-1439",
publisher = "Springer Verlag",
number = "3",

}

RIS

TY - JOUR

T1 - Clinical Characteristics and Outcome of Patients with Lacunar Infarcts and Concurrent Embolic Ischemic Lesions

AU - Barow, Ewgenia

AU - Boutitie, Florent

AU - Cheng, Bastian

AU - Cho, Tae-Hee

AU - Ebinger, Martin

AU - Endres, Matthias

AU - Fiebach, Jochen B

AU - Fiehler, Jens

AU - Ford, Ian

AU - Galinovic, Ivana

AU - Nickel, Alina

AU - Puig, Josep

AU - Roy, Pascal

AU - Wouters, Anke

AU - Thijs, Vincent

AU - Lemmens, Robin

AU - Muir, Keith W

AU - Nighoghossian, Norbert

AU - Pedraza, Salvador

AU - Simonsen, Claus Z

AU - Gerloff, Christian

AU - Thomalla, Götz

AU - WAKE-UP investigators

PY - 2020/9

Y1 - 2020/9

N2 - PURPOSE: Lacunar infarcts are thought to result from occlusion of small penetrating arteries due to microatheroma and lipohyalinosis, pathognomonic for cerebral small vessel disease (CSVD). Concurrent embolic ischemic lesions indicate a different stroke mechanism. The purpose of this study was to examine the clinical characteristics and outcome of patients with lacunar infarcts and concurrent embolic infarcts on diffusion-weighted imaging (DWI).METHODS: All patients screened for the WAKE-UP trial (ClinicalTrials.gov number, NCT01525290) were reviewed for acute lacunar infarcts and concurrent embolic lesions on baseline DWI. Clinical characteristics and outcome were compared between lacunar infarct patients with and without concurrent embolic lesions.RESULTS: Of 244 patients with an acute lacunar infarct, 20 (8.2%) had concurrent acute embolic infarcts. Compared to patients with a lacunar infarct only, patients with concurrent embolic infarcts were older (mean age 69 years vs. 63 years; p = 0.031), more severely affected (median National Institutes of Health Stroke Scale [NIHSS] score 5 vs. 4; p = 0.046), and-among those randomized-had worse functional outcome at 90 days (median modified Rankin Scale [mRS] 3 vs. 1; p = 0.011).CONCLUSION: Approximately 8% of lacunar infarct patients show concurrent embolic lesions suggesting a stroke etiology other than CSVD. These patients are more severely affected and have a worse functional outcome illustrating the need for a thorough diagnostic work-up of possible embolic sources even in patients with an imaging-defined diagnosis of lacunar infarcts.

AB - PURPOSE: Lacunar infarcts are thought to result from occlusion of small penetrating arteries due to microatheroma and lipohyalinosis, pathognomonic for cerebral small vessel disease (CSVD). Concurrent embolic ischemic lesions indicate a different stroke mechanism. The purpose of this study was to examine the clinical characteristics and outcome of patients with lacunar infarcts and concurrent embolic infarcts on diffusion-weighted imaging (DWI).METHODS: All patients screened for the WAKE-UP trial (ClinicalTrials.gov number, NCT01525290) were reviewed for acute lacunar infarcts and concurrent embolic lesions on baseline DWI. Clinical characteristics and outcome were compared between lacunar infarct patients with and without concurrent embolic lesions.RESULTS: Of 244 patients with an acute lacunar infarct, 20 (8.2%) had concurrent acute embolic infarcts. Compared to patients with a lacunar infarct only, patients with concurrent embolic infarcts were older (mean age 69 years vs. 63 years; p = 0.031), more severely affected (median National Institutes of Health Stroke Scale [NIHSS] score 5 vs. 4; p = 0.046), and-among those randomized-had worse functional outcome at 90 days (median modified Rankin Scale [mRS] 3 vs. 1; p = 0.011).CONCLUSION: Approximately 8% of lacunar infarct patients show concurrent embolic lesions suggesting a stroke etiology other than CSVD. These patients are more severely affected and have a worse functional outcome illustrating the need for a thorough diagnostic work-up of possible embolic sources even in patients with an imaging-defined diagnosis of lacunar infarcts.

KW - Embolic stroke

KW - Lacunar infarct

KW - MRI

KW - Stroke etiology

KW - WAKE-UP

U2 - 10.1007/s00062-019-00800-5

DO - 10.1007/s00062-019-00800-5

M3 - Journal article

C2 - 31161343

VL - 30

SP - 511

EP - 516

JO - Clinical neuroradiology

JF - Clinical neuroradiology

SN - 1869-1439

IS - 3

ER -