The course of patients with lacunar infarcts and a parent arterial lesion: Similarities to large artery vs small artery disease

Background: The significance of occlusive lesions of the parent artery in patients with lacunar syndrome (LS) and small deep infarcts (SDIs) on diffusion-weighted imaging remains unclear. Objective: To compare the recurrence of stroke in patients with LS and SDIs between those with vs without a parent arterial lesion. Design: Analysis of data from a prospective acute stroke registry. Setting: University hospital. Patients: Using clinical syndrome, diffusion-weighted imaging, and vascular studies, we divided 173 patients into 3 groups: (1) parent arterial disease occluding deep perforators (PAD), LS with SDIs, and a parent arterial lesion (n = 32); (2) small artery disease (SAD) (n = 70); and (3) large artery disease (LAD) (n = 71). Main Outcome Measures: Recurrent strokes and the prognosis were registered for 1 year, and the outcome of the PAD group was compared with that of the SAD and LAD groups. Results: During follow-up, there were 9 deaths (6 vascular) and 18 recurrent strokes. The recurrence rate in the PAD group (16%) was significantly higher than that in the SAD group (1%) (P=.01) but similar to that in the LAD group (17%) (P=.87). The presence of the parent arterial lesion was the only independent predictor of stroke recurrence in patients with LS and SDIs (odds ratio, 13.8; 95% confidence interval, 1.5-123.9; P=.02). Conclusions: Although LS on examination, SDIs on diffusion-weighted imaging, and a stable hospital course suggest lacunar stroke of benign course, our results indicate that the PAD group represents an intracranial type of LAD.