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(Stroke. 2004;35:1430.)
© 2004 American Heart Association, Inc.

Original Contributions

Predictive Values of Lacunar Transient Ischemic Attacks

Dominique Hervé, MD; Marion Gautier-Bertrand, BST; Julien Labreuche, BST Pierre Amarenco, MD for the GENIC Investigators

From the Department of Neurology and Stroke Center (D.H., J.L., P.A.), Bichat University Hospital and Medical School, Denis Diderot University; INSERM U360 (M.G.-B.); Formation de Recherche en Neurologie Vasculaire (D.H., J.L., P.A.), Association Claude Bernard, Paris, France. M.G.-B. and J.L. are biostatisticians.

Correspondence to Prof Pierre Amarenco, GENIC Study, Department of Neurology and Stroke Center, Bichat Hospital, 46 rue Henri Huchard, 75018 Paris. E-mail pierre.amarenco{at}bch.ap-hop-paris.fr

Background and Purpose— We postulated that a lacunar syndrome occurring with transient ischemic attacks (TIAs) or progressive nonsudden onset predicts a brain infarction (BI), presumably caused by a small artery disease (ie, lacunar BI) better than a lacunar syndrome with sudden onset.

Methods— We included 510 patients with BI. BI was classified into etiologic groups including lacunar BI group. We identified the patients with lacunar or nonlacunar syndrome, and those with TIAs preceding the BI or with symptoms of nonsudden onset.

Results— Nonlacunar syndrome had a negative predictive value for a lacunar BI of 95%. A lacunar syndrome had a positive predictive value (PPV) of 57% for lacunar infarction (n=109), and the PPV increased to 79% in the case of recent TIAs preceding the lacunar syndrome. Hypertension was present in 95% of cases with lacunar TIAs (odds ratio: 10.69; 95% confidence interval: 1.34 to 84.82; P=0.02).

Conclusions— Lacunar TIAs are almost always associated with history of arterial hypertension and have a high PPV for lacunar BI. This subgroup of patients may reflect different underlying mechanisms than the group of patient with lacunar syndrome of sudden onset.

Key Words: transient ischemic attack • cerebral infarction • lacunar infarction • predictive value of tests • hypertension

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