Extensive Workup for Embolic Sources in Lacunar Strokes: Prevalence in an Academic Setting (P1.043)

OBJECTIVE: To study the practice of extensive etiologic workup in lacunar stroke patients in an urban academic hospital setting. BACKGROUND: Small subcortical (lacunar) strokes occur in clinical settings and have prognostic implications distinct from infarctions due to large artery occlusions. While the two stroke types share certain risk factors, small subcortical strokes are more commonly caused by intrinsic microvascular disease than by thromboembolism from proximal sources. Thus, the clinical relevance and cost-effectiveness of extensive workup for thromboembolic sources in lacunar strokes has been questioned. DESIGN/METHODS: All admissions to the University of Chicago Medical Center with a principle diagnosis of stroke over a three year period were classified as lacunar strokes versus other stroke types according to pre- identified criteria. 25 lacunar stroke cases and 25 non-lacunar stroke cases were randomly sampled. Clinical features and imaging results were reviewed and recorded. RESULTS: 1841 patients with a coded diagnosis of stroke were admitted during the study period. Of these, 202 were readmitted patients. There were 637 confirmed ischemic strokes, 293 primary intracranial hemorrhages, 10 combined ischemic and hemorrhagic strokes, 849 non-acute stroke conditions, and 52 uncertain or unclassified cases. Of the 637 ischemic strokes, 100 were lacunar strokes, 19 were possible lacunes, and 518 were non-lacunar ischemic strokes. Of the 25 sampled lacunar stroke admissions, 17 had both echocardiography and intracranial vascular imaging; in comparison, 18 of 25 non-lacunar stroke admissions included both types of imaging. CONCLUSIONS: Lacunar strokes represent a substantial fraction of the ischemic strokes admitted in this urban hospital setting. These patients typically receive extensive work-up for thromboembolic sources similar to that applied to large artery strokes. Examination of clinical features and outcomes of lacunar stroke, and of the clinical utility of the extensive imaging, is warranted to guide best clinical practices. Disclosure: Dr. Wang has nothing to disclose. Dr. Choi has nothing to disclose. Dr. Gallardo has nothing to disclose. Dr. Nwaneri has nothing to disclose. Dr. Brorson has received personal compensation for activities with CVS Caremark Corporation as a legal consultant. Dr. Brorson has received research support from the National Institutes of Health.