Risk Factors and Outcome of Patients With Symptomatic Intracranial Stenosis Presenting With Lacunar Stroke

• Type of Material: Article
• Authors: Amir Khan, University of Pennsylvania; Scott E. Kasner, University of Pennsylvania; Michael Lynn, Emory University; Marc I. Chimowitz, Medical University of South Carolina
• Language: English
• Date: 2012-05-01
• Publisher: American Heart Association
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2012 American Heart Association, Inc.
• Final Published Version (URL): http://dx.doi.org/10.1161/STROKEAHA.111.641696
• Title of Journal or Parent Work: Stroke
• ISSN: 0039-2499
• Volume: 43
• Issue: 5
• Start Page: 1230
• End Page: 1233
• Grant/Funding Information: The WASID study was funded by a research grant (1R01 NS36643, Principal Investigator: Chimowitz MI) from the US Public Health Service, National Institute of Neurological Disorders and Stroke (NINDS).
• Keywords: Clinical Neurology; PROGNOSIS; Life Sciences & Biomedicine; INFARCTION; ARTERIAL-STENOSIS; prognosis; ISCHEMIC-STROKE; intracranial stenosis; POPULATION; DISEASE; RECURRENCE; Science & Technology; lacunar infarcts; Neurosciences & Neurology; Cardiovascular System & Cardiology; Peripheral Vascular Disease
• Research Categories: Biology, Neuroscience; Health Sciences, Medicine and Surgery

Abstract

Background and Purpose-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.