Low Yield of Extensive Workup for Embolic Sources in Lacunar Stroke Patients.
J Stroke Cerebrovasc Dis
; 27(6): 1575-1581, 2018 Jun.
Article
in En
| MEDLINE
| ID: mdl-29426678
ABSTRACT
OBJECTIVE:
We aimed to evaluate the yield of extensive etiologic workup in lacunar stroke patients.BACKGROUND:
As lacunar strokes are infrequently caused by thromboembolism, the clinical relevance of extensive workup for thromboembolic sources is questioned.METHODS:
Among consecutive stroke admissions to a single center over 3 years, the 100 cases initially classified as lacunar stroke and a sample of 100 cases classified as non-lacunar ischemic strokes were studied. Review of brain imaging resulted in reclassification of 24 cases, and exclusion of 3 cases, producing a final cohort of 86 confirmed lacunar strokes and 111 confirmed non-lacunar strokes. In each of these cases, results of echocardiographic and vascular imaging studies were evaluated.RESULTS:
Echocardiography was performed in 93% of both the lacunar stroke cases and non-lacunar stroke cases. High-risk cardiac embolic sources were found less often in lacunar than in non-lacunar stroke cases (19% versus 34%). Findings potentially requiring anticoagulant therapy were found exclusively in the non-lacunar stroke patients. Vascular imaging studies (computed tomography angiography or magnetic resonance angiography) were also performed in similar proportions of lacunar and non-lacunar stroke cases (85% versus 84%). Cerebrovascular occlusions or high-grade stenoses were frequent (62%) in non-lacunar stroke patients but less frequent (25%) in lacunar stroke patients. In the non-lacunar stroke patients, identified vascular lesions were very frequently in a vessel anatomically related to the infarction, but in lacunar stroke patients, this occurred in only 6 cases.CONCLUSIONS:
Echocardiography and vascular imaging studies rarely disclose findings of etiologic relevance, or of likelihood to change management, in patients with lacunar strokes.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Arterial Occlusive Diseases
/
Echocardiography
/
Brain Ischemia
/
Magnetic Resonance Angiography
/
Intracranial Embolism
/
Stroke, Lacunar
/
Computed Tomography Angiography
/
Heart Diseases
Type of study:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Country/Region as subject:
America do norte
Language:
En
Journal:
J Stroke Cerebrovasc Dis
Journal subject:
ANGIOLOGIA
/
CEREBRO
Year:
2018
Document type:
Article