Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/20983
Title: Clinical Characteristics and Outcome of Patients with Lacunar Infarcts and Concurrent Embolic Ischemic Lesions.
Authors: Barow, Ewgenia;Boutitie, Florent;Cheng, Bastian;Cho, Tae-Hee;Ebinger, Martin;Endres, Matthias;Fiebach, Jochen B;Fiehler, Jens;Ford, Ian;Galinovic, Ivana;Nickel, Alina;Puig, Josep;Roy, Pascal;Wouters, Anke;Thijs, Vincent N;Lemmens, Robin;Muir, Keith W;Nighoghossian, Norbert;Pedraza, Salvador;Simonsen, Claus Z;Gerloff, Christian;Thomalla, Götz
Affiliation: Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany..
Robertson Centre for Biostatistics, University of Glasgow, University Avenue, G12 8QQ, Glasgow, UK
Department of Neurology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
Department of Neurosciences, Experimental Neurology, KU Leuven-University of Leuven, Oude Markt 13, bus 5005, 3000, Leuven, Belgium
Laboratory of Neurobiology, Campus Gasthuisberg, VIB, Center for Brain & Disease Research, Herestraat 49, bus 602, 3000, Leuven, Belgium..
Service de Biostatistique, Hospices Civils de Lyon, 69003, Lyon, France
Université Lyon 1, 69100, Villeurbanne, France
CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, 69100, Villeurbanne, France..
Centrum für Schlaganfallforschung Berlin (CSB), Charité-Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany..
Neurologie, Rehaklinik Medical Park Humboldtmühle, An der Mühle 2-9, 13507, Berlin, Germany..
The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia
Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
Institute of Neuroscience & Psychology, University of Glasgow, University Avenue, G12 8QQ, Glasgow, UK
Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany..
Department of Stroke Medicine, CREATIS CNRS UMR 5220-INSERM U1206, INSA-Lyon, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France..
Centrum für Schlaganfallforschung Berlin (CSB), Charité-Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany..
Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany..
Centrum für Schlaganfallforschung Berlin (CSB), Charité-Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany..
Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany..
Department of Radiology, Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona (IDIBGI), Parc Hospitalari Martí i Julià de Salt-Edifici M2, 17190, Salt, Girona, Spain..
Department of Stroke Medicine, CREATIS CNRS UMR 5220-INSERM U1206, INSA-Lyon, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France..
Department of Radiology, Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona (IDIBGI), Parc Hospitalari Martí i Julià de Salt-Edifici M2, 17190, Salt, Girona, Spain..
Department of Neurology, Aarhus University Hospital, 8000, Aarhus, Denmark..
Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany..
Issue Date: 3-Jun-2019
EDate: 2019-06-03
Citation: Clinical neuroradiology 2019; online first: 3 June
Abstract: 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). 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. 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). 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.
URI: http://ahro.austin.org.au/austinjspui/handle/1/20983
DOI: 10.1007/s00062-019-00800-5
ORCID: 0000-0003-2318-0959
0000-0002-6614-8417
PubMed URL: 31161343
Type: Journal Article
Subjects: Embolic stroke
Lacunar infarct
MRI
Stroke etiology
WAKE-UP
Appears in Collections:Journal articles

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