Vascular retinal, neuroimaging and ultrasonographic markers of lacunar infarcts.

Background Lacunar infarcts may be caused by macro- or microvascular disease due to several mechanisms. Aim This study aims to demonstrate that retinal vascular disturbances in patients with lacunar infarcts associated with neuroimaging and ultrasound markers can help to identify small-vessel disease. Methods Prospective ambulatory study of patients with ischaemic stroke and a control group. A retinographic study was performed by 20° bilateral optic disc stereophotography and 50° bilateral optic fundus retinography. Microangiopathy was evaluated as the presence of nonparenchymal vascular affectation and retinopathy as at least one retinal disturbance. Ultrasonographic study evaluated carotid disorder parameters and the mean pulsatility index. The MRI protocol included T1-weighted, T2-weighted, DP-weighted and FLAIR. Results We included 156 nonlacunar infarcts, 39 lacunar infarcts and 50 controls. Microangiopathy was more frequent in hypertensive (62·6% vs. 35·7%, P<0·0001) and vascular retinopathy in diabetic patients (11·7% vs. 3·8%, P=0·039). Microangiopathy (97·4% vs. 41·1%, P<0·0001) and leukoaraiosis (94·4% vs. 50·3%, P<0·0001) were more frequent and the mean pulsatility index was higher (1·9 ± 0·2 vs. 1·4 ± 0·5, P<0·0001) in patients with lacunar infarcts. Lacunar infarcts were independently associated with microangiopathy (odds ratio 12·81, 95% CI 1·52–107·86), the mean pulsatility index (odds ratio 8·13, 95% CI 1·17–56·20) and leukoaraiosis (odds ratio 3·45, 95% CI 1·09–10·93). The presence of leukoaraiosis plus microangiopathy was associated with lacunar infarcts with odds ratio 21·31 (95% CI 8·74–51·93). Conclusions The association of retinal microangiopathy (but not vascular retinopathy) and leukoaraiosis is linked to small-vessel disease and may be a useful marker of lacunar infarcts not secondary to a macrovascular lesion.