Abstract 2724: Comparison Of Hypertensive And Non-hypertensive Lacunar Infarcts

Abstract

Background: Hypertension and arteriolosclerosis in perforating arteries are the most common hypothetical pathogenesis in lacunar infarcts so far. Few studies on non-hypertensives have been inconsistent, partly because of unavoidable misclassification of lacunar infarcts. Using a DWI MRI-based stroke classification algorithm, we aimed to compare the clinical and laboratory characteristics of patients with lacunar infarction by the presence of hypertension. Methods: A consecutive series of patients, who were hospitalized due to acute ischemic stroke to 9 centers that were participating in the ‘Clinical Research Center for Stroke’ program funded by the Korean government, were registered prospectively between April 2008 and March 2010. Lacunar infarct was defined as a single DWI lesion less than 2cm in perforator territories without relevant artery steno-occlusion or cardiac embolic sources. Correlates of nonhypertensive lacunar infarction were obtained by multiple logistic regression analysis. Results: Among 6696 stroke patients, 1340 (20.0%) showed lacunar infarcts. Lacunar infarct patients without hypertension showed less frequent diabetes mellitus, hyperlipidemia, previous stroke history, ischemic heart disease, prior use of antiplatelets, and prior use of statin than hypertensive patients with lacunar infarct. Body mass index, plasma glucose, and serum creatinine level were also lower, while smoking and HDL level were higher in non-hypertensive patients. Initial NIHSS score and the frequency of early neurological deterioration (NIHSS score increase 1 point or higher on discharge than initial) and good outcome (3month mRS ≤ 1) were not different in two groups. After multivariable analysis, age (odds ratio 0.987, 95% CI 0.977 to 0.998), diabetes (OR 0.665, 95% CI 0.487 to 0.907), stroke history (OR 0.512, 95% CI 0.358 to 0.733), and BMI (OR 0.899, 95% CI 0.862 to 0.938) seemed to be independent factors associated with lacunar infarct in nonhypertensives compared to lacunar infarction in hypertensives. Conclusion: This study shows that non-hypertensives with lacunar stroke seem to be younger, and have less frequent diabetes and stroke history, and lower BMI than hypertensives with lacunar stroke. Stroke severity and outcome were not different in lacunar infarct patients with or without hypertension.