Prognosis of Lacunar Stroke Patients in Association with Leukoaraiosis
Background: Leukoaraiosis (LA) is a frequent finding on CT scans of patients with vascular risk factors and cerebrovascular disease, particularly in those with lacunar stroke. Both conditions appear to be linked by a common pathophysiological mechanism, namely small vessel disease. Objective: To characterize the relationship between lacunar stroke and LA, and to correlate with the risk of recurrent lacunar stroke. Patients & Methods: Baseline CT scans of NASCET participants with stroke as the index event were assessed for the presence and severity of LA by two readers independently unaware of clinical data. Results: Four groups based on the type of index stroke and on the presence of LA were formed: a) no lacunar stroke & no LA (n=437), 2) non lacunar stroke & LA (n=153), c) lacunar stroke & no LA (n=365), d) lacunar stroke & LA (n=76). Baseline characteristics different among the groups were: age >65 years (53, 76, 56, 63% respectively p<0.001), hyperlipidemia (30, 20, 37, 29% respectively p=0.002), smoking (42, 28, 41, 45, 42% respectively p=0.02) and degree of carotid stenosis 50–99% (52, 44, 45, 34% respectively p=0.01). Patients with LA were 2.9 times more likely to have multiple lacunes on CT (p=0.001). The risk of lacunar stroke at 5 years increased across the four groups (5, 8, 10 and 11% respectively p=0.02), after adjusting for all baseline characteristics. Conclusions: The presence of leukoaraiosis in lacunar stroke patients is associated with higher number of lacunar infarcts and strongly predicts the likelihood of developing a subsequent lacunar stroke. Our findings support the hypothesis that both conditions are caused by the same pathological entity in this patient population.