Citation Information :
Singh H, Mohan G. To Study the Incidence of Lacunar Infarcts in Patients with Acute Ischemic Stroke and its Correlation with Carotid Artery Stenosis. Curr Trends Diagn Treat 2018; 2 (2):88-91.
Introduction: Stroke remains the second leading cause of death worldwide, after ischemic heart disease. Lacunar infarcts are small deep infarcts ranging from 2 to 20 mm in size resulting from occlusion of a penetrating artery which accounts for approximately 25% of all ischemic strokes. The present study was undertaken to study the incidence of lacunar infarcts in patients with acute ischemic stroke and its correlation with carotid stenosis.
Methods: This study was performed at the Department of Medicine at a tertiary-care hospital in Amritsar, Punjab, in 50 patients presenting with acute ischemic stroke with or without lacunar syndrome. All patients were diagnosed using diffusionweighted imaging (DWI) on magnetic resonance imaging (MRI) of the brain. Carotid artery stenosis was measured with duplex ultrasound.
Results: Patients with acute ischemic stroke had a mean age of 61.36 ± 11.36 years. About 40% of the patients had lacunar infarcts with a higher frequency in male patients (64% vs 36%). There was no significant difference found in the incidence of hypertension (85% vs 70%), diabetes (20% vs 13.3%, p value = 0.529), alcohol drinking (20% vs 16.67.0%, p value = 0.764), smoking (23% vs 10% p value = 0.318), and carotid artery stenosis (35% vs 43.3%, p value = 0.828) between lacunar and non-lacunar infarct patients.
Conclusion: The difference in the incidence of potential risk factors such as hypertension, diabetes mellitus, alcoholism, smoking, and dyslipidemia was found to be statistically insignificant between lacunar and non-lacunar infarct groups. Carotid stenosis did not show any significant difference in the lacunar and non-lacunar infarct groups. The findings in our study are consistent with the hypothesis that severe carotid artery stenosis in lacunar infarction is an incidental finding.
Longo DL, Kasper DL, Kauser SL, et al. Harrison's principle of internal medicine. Edisi ke-18.
Murray CJ, Lopez AD. Mortality by cause for eight regions of the world: global burden of disease study. Lancet 1997 May 3;349(9061):1269-1276. doi: 10.1016/S0140-6736(96)07493-4.
Fisher CM. Lacunes: small, deep cerebral infarcts. Neurology 2011;77(24):2104. doi: 10.1212/01.wnl.0000410087.34228.7d.
Landi G, Anzalone N, Cella E, et al. Are sensorimotor strokes lacunar strokes? A case-control study of lacunar and non-lacunar infarcts. J Neurol Neurosurg Psychiatry 1991;54(12):1063-
Fisher CM, Curry HB. Pure motor hemiplegia of vascular origin. Arch Neurol 1965;13(1):30-44.
Fisher CM. Lacunar strokes and infarcts: a review. Neurology 1982 Aug 1;32(8):871-876.
Inzitari D, Eliasziw M, Gates P, et al. The causes and risk of stroke in patients with asymptomatic internal-carotid-artery stenosis. N Engl J Med 2000 Jun 8;342(23):1693-1701. doi: 10.1056/NEJM200006083422302.
Kaul S, Alladi S, Jabeen SA, et al. Intracranial atherosclerosis is the most common stroke subtype: ten-year data from Hyderabad stroke registry (India). Ann Indian Acad Neurol 2018 Jul;21(3):209. doi: 10.4103/aian.AIAN_86_18.
Gross CR, Kase CS, Mohr JP, et al. Stroke in south Alabama: incidence and diagnostic features – a population based study. Stroke 1984 Mar 1;15(2):249-255.
Saha A, Sinha PK, Paul R, et al. Study of carotid intima media thickness and its correlation with novel risk factors in ischemic stroke. Neurol Asia 2011 Mar 1;16(1):25-31.
Fernandes M, Prasad N, Mahale AR, et al. Common carotid artery intima media thickness measurement in cerebral ischemic stroke patients using ultrasonography: a prospective study. International Journal of Anatomy, Radiology and Surgery. 2016 July. Available from http://www.ijars.net/ back_issues.asp?issn=2277-8543&year=2016&month=July& volume=5&issue=3&page=-&id=2158.
Tegeler CH, Shi F, Morgan T. Carotid stenosis in lacunar stroke. Stroke 1991 Sep 1;22(9):1124-1128.
Warlow C, Sudlow C, Dennis M, et al. Stroke. Lancet 2003;362(9391):1211-1224. doi: 10.1016/S0140-6736(03)14544-8.
Homburg PJ, Rozie S, van Gils MJ, et al. Association between carotid artery plaque ulceration and plaque composition evaluated with multidetector CT angiography. Stroke 2011 Feb 1;42(2):367-372. doi: 10.1161/STROKEAHA.110.597369.
Mead GE, Wardlaw JM, Lewis SC, et al. Can simple clinical features be used to identify patients with severe carotid stenosis on Doppler ultrasound? J Neurol Neurosurg Psychiatry 1999 Jan 1;66(1):16-19. doi: 10.1136/jnnp.66.1.16.