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Low Yield of Extensive Workup for Embolic Sources in Lacunar Stroke Patients.
- Source :
-
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association [J Stroke Cerebrovasc Dis] 2018 Jun; Vol. 27 (6), pp. 1575-1581. Date of Electronic Publication: 2018 Feb 06. - Publication Year :
- 2018
-
Abstract
- Objective: We aimed to evaluate the yield of extensive etiologic workup in lacunar stroke patients.<br />Background: As lacunar strokes are infrequently caused by thromboembolism, the clinical relevance of extensive workup for thromboembolic sources is questioned.<br />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.<br />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.<br />Conclusions: Echocardiography and vascular imaging studies rarely disclose findings of etiologic relevance, or of likelihood to change management, in patients with lacunar strokes.<br /> (Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Arterial Occlusive Diseases complications
Arterial Occlusive Diseases therapy
Brain Ischemia etiology
Brain Ischemia therapy
Chicago
Diffusion Magnetic Resonance Imaging
Female
Heart Diseases complications
Heart Diseases therapy
Humans
Intracranial Embolism etiology
Intracranial Embolism therapy
Male
Middle Aged
Predictive Value of Tests
Prognosis
Retrospective Studies
Risk Factors
Stroke, Lacunar etiology
Stroke, Lacunar therapy
Arterial Occlusive Diseases diagnostic imaging
Brain Ischemia diagnostic imaging
Computed Tomography Angiography
Echocardiography
Heart Diseases diagnostic imaging
Intracranial Embolism diagnostic imaging
Magnetic Resonance Angiography
Stroke, Lacunar diagnostic imaging
Subjects
Details
- Language :
- English
- ISSN :
- 1532-8511
- Volume :
- 27
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
- Publication Type :
- Academic Journal
- Accession number :
- 29426678
- Full Text :
- https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.01.009