Clinical Characteristics in Lacunar Infarction with Less Than 50% Stenosis in the Parent Artery

Background: Contrary to the initial hypothesis, there is accumulating evidence that the pathogenesis of lacunar infarction (LI) is heterogeneous. LI is often accompanied by intracranial stenosis, and while the clinical significance of severe stenosis of the intracranial parent artery in LI has been demonstrated, that of mild stenosis in LI has not been. Thus the aim of this study was to determine the clinical relevance of mild intracranial stenosis in LI. Methods: Ninety-three consecutive patients with acute LI were enrolled between March 2011 and December 2013. The patients were divided according to the presence of intracranial stenosis in the parent artery into pure LI (PLI) and LI with mild intracranial stenosis (<50% stenosis, BAD). Various clinical and laboratory characteristics were compared between the two groups. Results: PLI group were older and, had a less frequent history of smoking, a larger infarct, lower likelihood of a favorable outcome, and higher National Institute of Health Stroke Scale score at discharge in the univariate analysis. After adjusting for confounding factors, BAD was associated with older age at onset [odds ratio (OR) = 1.113, 95% confidence interval (95% CI) = 1.056-1.172, p<0.001), no history of previous statin medication (OR = 13.362, 95% CI = 1.014-176.062, p=0.049), and nonsignificant stenosis in the parent artery was associated with larger infarct (β=0.296, p=0.01) in the multivariate analyses. Conclusions: LI with mild parent-artery disease was demonstrated to have distinct clinical characteristics compared to LI without parent artery disease. Thus, even mild branch atheromatous disease in LI should be evaluated thoroughly and treated via a planned and systematic approach. J Korean Neurol Assoc 33(2):82-88, 2015