Differences of risk factors and pathologies between the single and multiple lacunar infarctions

Abstract

Objective To investigate the characteristics of single lacunar infarct (SLI) and ipsilateral multiple lacunar infarction (MLI), and the differences of risk factors and and pathologies between them. Methods The clinical data of all patients with cerebral infarction in acute internal carotid artery territory from August 1, 2008 to December 13, 2014 were analyzed retrospectively. Lacunar infarctions were screened according to the clinical manifestations and imaging findings. The patients were divided into a SLI, a unilateral MLI in the same blood supply area (MLI 1) and a unilateral MLI in the different blood supply area (MLI 2) group according to the number and location of the lesions showed on diffusion weighted imaging. Multivariate logistic regression analysis was used to identify potential independent risk factors. Results The incidences of ipsilateral carotid plaque (73.33% vs. 48.67%; χ2=5.801, P=0.016), ipsilateral unstable carotid plaque (70.0% vs. 42.5%; χ2=7.192, P=0.007), and ipsilateral carotid stenosis ≥50% (16.67% vs. 1.77%; χ2=8.327, P=0.004) of the MLI 1 group were significantly higher than those of the SLI group; the incidence of atrial fibrillation of the MLI 2 group was significantly higher than that of the SLI group (40.0% vs. 0.88%; χ2=15.887, P<0.001); there were no significant differences in the remaining risk factors among each group. Multivariate logistic regression analysis showed that atrial fibrillation (odds ratio [OR] 14.452, 95% confidence interval [CI] 1.558-134.011; P=0.019) and ipsilateral carotid stenosis ≥50% (OR 11.483, 95% CI 2.202-59.891; P=0.011) were the independent risk factors for MLI. Conclusions MLI may have different risk factors and pathogeneses with SLI. Atherosclerotic lesions and embolism are the important pathogeneses of MLI, while SLI is not. Key words: Stroke, Lacunar; Carotid Stenosis; Atherosclerosis; Atrial Fibrillation; Magnetic Resonance Imaging; Risk Factors