Two Types of Lacunar Infarcts: Further Arguments From a Study on Prognosis

Background and Purpose— Earlier, we found that lacunar stroke patients with ≥1 asymptomatic lacunar infarcts on CT had leukoaraiosis and hypertension significantly more often than patients without such lesions, and we hypothesized that 2 types of small-vessel disease could be distinguished during life: arteriolosclerosis and microatheromatosis, respectively. Differences in prognosis might sustain this hypothesis of 2 lacunar stroke entities. Therefore, we performed a follow-up in 333 patients with first lacunar stroke, distinguishing those with ≥1 asymptomatic lacunar lesions (LACI+) from those without such lesions (LACI−). Methods— Cross-sectional follow-up was performed after 785±479 days (mean±SD) in 104 LACI+ patients and 865±545 days in 229 LACI− patients. Results— Mortality at the end of follow-up was 33% in LACI+ and 21% in LACI− patients [odds ratio (OR), 1.74; 95% confidence interval (CI), 1.01 to 3.01]. Stroke recurrence rate was 21% in LACI+ and 11% in LACI− (OR, 2.09; 95% CI, 1.08 to 4.06). Forty percent of LACI+ and 26% of LACI− patients had unfavorable outcome at the end of follow-up (OR, 1.95; 95% CI, 1.17 to 3.26). Kaplan-Meier curves showed less favorable survival in LACI+ (log-rank test, P =0.0218) and survival free of stroke (log-rank test, P =0.0121) than in LACI−. When we restricted the analysis to patients with both silent lesions and leukoaraiosis (n=63) compared with those without (n=196), differences were even more pronounced. Conclusions— Prognosis for mortality, recurrent stroke, and overall functional outcome in lacunar stroke patients with ≥1 silent lacunar lesions is more unfavorable than in patients without such lesions. These findings sustain the idea of 2 lacunar stroke entities.