Lacunar Stroke: Mechanisms and Therapeutic Implications
Cerebrovascular disease J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp-2021-326308 on 26 May 2021. Downloaded from Review Lacunar stroke: mechanisms and therapeutic implications Shadi Yaghi ,1 Eytan Raz ,2 Dixon Yang,2,3 Shawna Cutting,1 Brian Mac Grory,4 Mitchell SV Elkind,5 Adam de Havenon 6 1Department of Neurology, ABSTRACT overall prevalence of these risk factors is similar Brown University Warren Alpert Lacunar stroke is a marker of cerebral small vessel between lacunar stroke and other stroke subtypes,8 Medical School, Providence, some studies suggest that smoking, hypertension Rhode Island, USA disease and accounts for up to 25% of ischaemic 2Department of Radiology, NYU stroke. In this narrative review, we provide an overview and diabetes are particularly important risk factors Langone Health, New York, New of potential lacunar stroke mechanisms and discuss for lacunar stroke3 7 and that these risk factors may 9 York, USA be more prevalent in patients with lacunar stroke. 3 therapeutic implications based on the underlying Department of Neurology, NYU mechanism. For this paper, we reviewed the literature Among these risk factors, hypertension is most Langone health, New York, New York, USA from important studies (randomised trials, exploratory common in patients with lacunar stroke (68%), 3 7 9 4Department of Neurology, comparative studies and case series) on lacunar stroke followed by diabetes (30%). These studies were Duke Medicine, Durham, North patients with a focus on more recent studies highlighting performed when the control of risk factors, partic- Carolina, USA mechanisms and stroke prevention strategies in ularly hypertension, was less aggressive and more 5Department of Neurology, patients with lacunar stroke.
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