Differences between ischemic stroke subtypes in vascular outcomes support a distinct lacunar ischemic stroke arteriopathy: a prospective, hospital-based study

Jackson, Caroline A., Hutchison, Aidan, Dennis, Martin S., Wardlaw, Joanna M., Lewis, Steff C. and Sudlow, Cathie L.M. (2009) Differences between ischemic stroke subtypes in vascular outcomes support a distinct lacunar ischemic stroke arteriopathy: a prospective, hospital-based study. Stroke, 40 12: 3679-3684. doi:10.1161/STROKEAHA.109.558221


Author Jackson, Caroline A.
Hutchison, Aidan
Dennis, Martin S.
Wardlaw, Joanna M.
Lewis, Steff C.
Sudlow, Cathie L.M.
Title Differences between ischemic stroke subtypes in vascular outcomes support a distinct lacunar ischemic stroke arteriopathy: a prospective, hospital-based study
Journal name Stroke   Check publisher's open access policy
ISSN 0039-2499
1524-4628
Publication date 2009-12
Sub-type Article (original research)
DOI 10.1161/STROKEAHA.109.558221
Volume 40
Issue 12
Start page 3679
End page 3684
Total pages 6
Place of publication Philadelphia, PA, United States
Publisher Lippincott Williams & Wilkins
Language eng
Formatted abstract
Background and Purpose— Whether and how the arterial pathology underlying lacunar ischemic stroke differs from the atherothrombotic processes causing most other ischemic strokes is still debated. Different risks of recurrent stroke and MI after lacunar versus nonlacunar ischemic stroke may support a distinct lacunar arteriopathy.
Methods— We prospectively followed a hospital-based cohort of 809 first-ever ischemic stroke patients for 1 to 4 years. We compared risks of death, recurrent stroke, and MI in patients with lacunar versus nonlacunar stroke, and performed an updated meta-analysis of recurrent stroke subtype patterns.
Results— During 1725 person-years of follow-up, 109 patients had a recurrent stroke and 31 had MI. All patients at baseline, and 93% with recurrent stroke, had brain imaging and more than half with recurrent stroke had diffusion-weighted MRI. Overall, there was no difference in recurrence risk after lacunar vs nonlacunar stroke, although there was a trend toward a lower recurrence risk in the early weeks after lacunar stroke. Lacunar recurrence was more likely after lacunar than nonlacunar stroke (OR, 6.5; 95% CI, 2.4–17.5; updated meta-analysis OR, 6.8; 95% CI, 4.2–11.2). MI risk was nonsignificantly lower after lacunar than nonlacunar stroke (rate ratio, 0.5; 95% CI, 0.2–1.1; rate ratio after excluding patients with previous ischemic heart disease: 0.3; 95% CI, 0.1–0.9).
Conclusions— Our finding of a trend toward a lower MI risk after lacunar vs nonlacunar stroke and confirmation of both a lower early recurrence risk after lacunar stroke and a tendency of recurrent stroke subtypes to “breed true” support the notion of a distinct nonatherothrombotic lacunar arteriopathy.
Keyword Ischemic stroke
Lacunar
Myocardial infarction
Outcome
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Public Health Publications
 
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