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(Stroke. 2002;33:2072.)
© 2002 American Heart Association, Inc.

Original Contributions

Two Types of Lacunar Infarcts

Further Arguments From a Study on Prognosis

G. de Jong, MD, PhD; F. Kessels, MD, MSc J. Lodder, MD, PhD

From the Department of Neurology, Isala Clinics Location Weezenlanden, Zwolle (G. d L.), and Department of Clinical Epidemiology and Medical Technology Assessment (F.K.) and Department of Neurology (J.L.), University Hospital Maastricht, Maastricht, the Netherlands.

Correspondence to J. Lodder, Department of Neurology, University Hospital Maastricht, Postbus 5800, 6202 AZ Maastricht, Netherlands. E-mail jlod{at}sneu.azm.nl

Background and Purpose— Earlier, we found that lacunar stroke patients with 1 asymptomatic lacunar infarcts on CT had leukoaraiosis and hypertension significantly more often than patients without such lesions, and we hypothesized that 2 types of small-vessel disease could be distinguished during life: arteriolosclerosis and microatheromatosis, respectively. Differences in prognosis might sustain this hypothesis of 2 lacunar stroke entities. Therefore, we performed a follow-up in 333 patients with first lacunar stroke, distinguishing those with 1 asymptomatic lacunar lesions (LACI+) from those without such lesions (LACI-).

Methods— Cross-sectional follow-up was performed after 785±479 days (mean±SD) in 104 LACI+ patients and 865±545 days in 229 LACI- patients.

Results— Mortality at the end of follow-up was 33% in LACI+ and 21% in LACI- patients [odds ratio (OR), 1.74; 95% confidence interval (CI), 1.01 to 3.01]. Stroke recurrence rate was 21% in LACI+ and 11% in LACI- (OR, 2.09; 95% CI, 1.08 to 4.06). Forty percent of LACI+ and 26% of LACI- patients had unfavorable outcome at the end of follow-up (OR, 1.95; 95% CI, 1.17 to 3.26). Kaplan-Meier curves showed less favorable survival in LACI+ (log-rank test, P=0.0218) and survival free of stroke (log-rank test, P=0.0121) than in LACI-. When we restricted the analysis to patients with both silent lesions and leukoaraiosis (n=63) compared with those without (n=196), differences were even more pronounced.

Conclusions— Prognosis for mortality, recurrent stroke, and overall functional outcome in lacunar stroke patients with 1 silent lacunar lesions is more unfavorable than in patients without such lesions. These findings sustain the idea of 2 lacunar stroke entities.

Key Words: arterioles • arteriosclerosis • lacunar infarction • prognosis • small-vessel disease

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