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    Clinical Characteristics and Outcome of Patients with Lacunar Infarcts and Concurrent Embolic Ischemic Lesions

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    Author
    Barow, E; Boutitie, F; Cheng, B; Cho, T-H; Ebinger, M; Endres, M; Fiebach, JB; Fiehler, J; Ford, I; Galinovic, I; ...
    Date
    2020-09-01
    Source Title
    Clinical Neuroradiology
    Publisher
    SPRINGER HEIDELBERG
    University of Melbourne Author/s
    Thijs, Vincent
    Affiliation
    Florey Department of Neuroscience and Mental Health
    Metadata
    Show full item record
    Document Type
    Journal Article
    Citations
    Barow, E., Boutitie, F., Cheng, B., Cho, T. -H., Ebinger, M., Endres, M., Fiebach, J. B., Fiehler, J., Ford, I., Galinovic, I., Nickel, A., Puig, J., Roy, P., Wouters, A., Thijs, V., Lemmens, R., Muir, K. W., Nighoghossian, N., Pedraza, S. ,... Thomalla, G. (2020). Clinical Characteristics and Outcome of Patients with Lacunar Infarcts and Concurrent Embolic Ischemic Lesions. CLINICAL NEURORADIOLOGY, 30 (3), pp.511-516. https://doi.org/10.1007/s00062-019-00800-5.
    Access Status
    Access this item via the Open Access location
    URI
    http://hdl.handle.net/11343/253906
    DOI
    10.1007/s00062-019-00800-5
    Open Access URL
    http://eprints.gla.ac.uk/186596/7/186596.pdf
    Abstract
    PURPOSE: 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). METHODS: 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. RESULTS: 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). CONCLUSION: 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.

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