Research Article| Volume 25, ISSUE 6, P1381-1388, June 2016

Risk Factors for Lacunar Strokes with Visible Cerebral Lesions on Computed Tomography Scan


      The aim of this study was the detection of risk factors for lacunar strokes with visible lesions on computed tomography (CT) scan, considering in particular clinical characteristics, echocardiographic parameters, and carotid–femoral pulse wave velocity (PWV, a marker of large-artery stiffness). Lacunar strokes with very small or nonvisible lesions may have different risk factors.


      We examined 106 patients (mean age 66.9 ± 12.3 years, 60 men), including 55 patients with clinically lacunar stroke associated with deep ischemic lesions of .3-1.5 cm on brain CT scan, and 51 control patients with cortical ischemic stroke, with lesions of 2.5-10.0 cm.


      In multiple logistic regression, with respect to cortical strokes, the following variables were independently associated with lacunar strokes: tricuspid regurgitation velocity (inverse relationship, odds ratio [OR] .13, 95% confidence interval [CI] .04-.43, P = .0007, cutoff at 228 cm/s), mean systolic blood pressure (SBP) (OR 3.98, 95% CI 2.78-7.79, P = .008, cutoff at 145 mmHg), ever-smoker status (OR 2.68, 95% CI 1.06-6.80, P = .04), and atrial fibrillation (inverse relationship, OR .11, 95% CI .01-1.00, P = .0496). In univariate analysis, the patients with lacunar stroke also had a lower prevalence of mitral regurgitation. There were no differences between the 2 groups in relation to diabetes, cholesterol, left ventricular mass and dimensions, and PWV.


      The patients with lacunar strokes with visible cerebral lesions on CT scan, compared with the patients with cortical infarct, had a lower tricuspid regurgitation velocity, a higher mean SBP, a greater prevalence of ever-smokers, and a lower prevalence of atrial fibrillation.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Stroke and Cerebrovascular Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Boiten J.
        • Lodder J.
        • Kessels F.
        Two clinically distinct lacunar infarct entities? A hypothesis.
        Stroke. 1993; 24: 652-656
        • Khan U.
        • Porteous L.
        • Hassan A.
        • et al.
        Risk factor profile of cerebral small vessel disease and its subtypes.
        J Neurol Neurosurg Psychiatry. 2007; 78: 702-706
        • Spolveri S.
        • Baruffi M.C.
        • Cappelletti C.
        • et al.
        Vascular risk factors linked to multiple lacunar infarcts.
        Cerebrovasc Dis. 1998; 8: 152-157
        • Muscari A.
        • Puddu G.M.
        • Fabbri E.
        • et al.
        Factors predisposing to small lacunar versus large non-lacunar cerebral infarcts: is left ventricular mass involved?.
        Neurol Res. 2013; 35: 1015-1021
        • Bamford J.
        • Sandercock P.
        • Dennis M.
        • et al.
        Classification and natural history of clinically identifiable subtypes of cerebral infarction.
        Lancet. 1991; 337: 1521-1526
        • O'Rourke M.F.
        • Safar M.E.
        Relationship between aortic stiffening and microvascular disease in brain and kidney: cause and logic of therapy.
        Hypertension. 2005; 46: 200-204
        • Kim D.H.
        • Kim J.
        • Kim J.M.
        • et al.
        Increased brachial-ankle pulse wave velocity is independently associated with risk of cerebral ischemic small vessel disease in elderly hypertensive patients.
        Clin Neurol Neurosurg. 2008; 110: 599-604
        • Ohmine T.
        • Miwa Y.
        • Yao H.
        • et al.
        Association between arterial stiffness and cerebral white matter lesions in community-dwelling elderly subjects.
        Hypertens Res. 2008; 31: 75-81
        • Seo W.K.
        • Lee J.M.
        • Park M.H.
        • et al.
        Cerebral microbleeds are independently associated with arterial stiffness in stroke patients.
        Cerebrovasc Dis. 2008; 26: 618-623
        • Poels M.M.
        • Zaccai K.
        • Verwoert G.C.
        • et al.
        Arterial stiffness and cerebral small vessel disease: the Rotterdam Scan Study.
        Stroke. 2012; 43: 2637-2642
        • Lyden P.
        • Lu M.
        • Jackson C.
        • et al.
        Underlying structure of the National Institutes of Health Stroke Scale: results of a factor analysis. NINDS tPA Stroke Trial Investigators.
        Stroke. 1999; 30: 2347-2354
        • Wardlaw J.M.
        • Lewis S.
        Carotid stenosis measurement on colour Doppler ultrasound: agreement of ECST, NASCET and CCA methods applied to ultrasound with intra-arterial angiographic stenosis measurement.
        Eur J Radiol. 2005; 56: 205-211
        • Devereux R.B.
        • Alonso D.R.
        • Lutas E.M.
        • et al.
        Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings.
        Am J Cardiol. 1986; 57: 450-458
        • Dubois D.
        • Dubois E.F.
        A formula to estimate the approximate surface area if height and weight be known.
        Arch Intern Med. 1916; 17: 863-871
        • Tei C.
        • Kisanuki A.
        • Minagoe S.
        • et al.
        Incidence of tricuspid regurgitation in normal subjects according to a new Doppler echographic criterion.
        J Cardiol. 1987; 17 (in Japanese): 551-558
        • Yock P.G.
        • Popp R.L.
        Noninvasive estimation of right ventricular systolic pressure by Doppler ultrasound in patients with tricuspid regurgitation.
        Circulation. 1984; 70: 657-662
        • Park J.H.
        • Shin S.H.
        • Lee M.J.
        • et al.
        Clinical and echocardiographic factors affecting tricuspid regurgitation severity in the patients with lone atrial fibrillation.
        J Cardiovasc Ultrasound. 2015; 23: 136-142
        • Zhou X.
        • Otsuji Y.
        • Yoshifuku S.
        • et al.
        Impact of atrial fibrillation on tricuspid and mitral annular dilatation and valvular regurgitation.
        Circ J. 2002; 66: 913-916
        • de Leeuw F.E.
        • de Groot J.C.
        • Oudkerk M.
        • et al.
        Hypertension and cerebral white matter lesions in a prospective cohort study.
        Brain. 2002; 125: 765-772
        • Vermeer S.E.
        • Koudstaal P.J.
        • Oudkerk M.
        • et al.
        Prevalence and risk factors of silent brain infarcts in the population-based Rotterdam Scan Study.
        Stroke. 2002; 33: 21-25
        • Masugata H.
        • Senda S.
        • Hoshikawa J.
        • et al.
        Elevated brachial-ankle pulse wave velocity is associated with left ventricular hypertrophy in hypertensive patients after stroke.
        Tohoku J Exp Med. 2010; 220: 177-182