Lancet sub-issue: 500,000 Chinese studies suggest that lacunar cerebral infarction is not harmless, and the 5-year recurrence rate is nearly 40%!

Silent lacunar infarction (LACI) is an insidious cerebral ischemic lesion that usually presents with nonspecific or atypical neurological symptoms but without acute stroke
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LACI, or Lacunes, are small cerebral infarcts (<15 mm in diameter), round or oval, mainly in the deep arteriole regions of the subcortical region of the brain, accounting for approximately 20% of all ischemic strokes (IS) -35%

Stroke LACI, or Lacunes, are small cerebral infarcts (<15 mm in diameter), round or oval in shape, mainly in the deep arteriole areas of the subcortical region of the brain, accounting for approximately all ischemic strokes (IS) 20-35%

Vessels include white matter hyperplasia (WMH), perivascular space (PVS), cerebral microbleeds (CMB), and brain atrophy

Lancet

In a prospective study of 489,597 Chinese adults with no history of stroke or ischemic heart disease at baseline, the researchers compared the 5-year risk of recurrent stroke and all-cause death for silent lacunar infarction with symptomatic lacunar infarction
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Data on recurrent stroke and all-cause mortality were obtained by linking with local stroke and death registries and health insurance records for all hospital admissions

Of the 12,150 cases adjudicated to be diagnosed with first-time LACI, 4,134 (34%) were occult LACI and 8,016 (66%) were symptomatic LACI
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Brain imaging was available in all cases, but only 33% of occult LACI and 40% of symptomatic LACI cases had brain magnetic resonance imaging (MRI)

diagnosis

Overall, the incidence of occult LACI was twice as high in urban areas as in rural areas, but rates of occult LACI versus symptomatic LACI were similar in all regions
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The 5-year risk of recurrent stroke (38% vs 43%) and the risk of all-cause mortality (11% vs 14%) were comparable between occult LACI and symptomatic LACI cases, respectively

Overall, the incidence of occult LACI was twice as high in urban areas as in rural areas, but rates of occult LACI versus symptomatic LACI were similar in all regions

Cumulative event rate of recurrent stroke and all-cause death within 28 days of first ischemic stroke event

For occult and symptomatic LACI cases, the majority of recurrent stroke cases were non-LACI (70% vs 72%)
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While the relative risk of recurrent stroke did not differ by age, sex, and region, the absolute risk of all-cause mortality varied by sex, age, and region

For occult and symptomatic LACI cases, the majority of recurrent stroke cases were non-LACI (70% vs 72%)

To sum up, among all asymptomatic LACI cases, nearly 40% of patients experienced stroke recurrence within 5 years, and nearly 10% of patients died, which is similar to the recurrence rate and all-cause mortality of symptomatic LACI! To sum up, among all asymptomatic LACI cases, nearly 40% of patients experienced stroke recurrence within 5 years, and nearly 10% of patients died, which is similar to the recurrence rate and all-cause mortality of symptomatic LACI!

 

references:

Natural history of silent lacunar infarction: 10-year follow-up of a community-based prospective study of 0.

Natural history of silent lacunar infarction: 10-year follow-up of a community-based prospective study of 0.
5 million Chinese adults.
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