Document Detail


Differences in long-term survival in two lacunar stroke types: a 15-year follow-up study in 782 cerebral infarct patients.
MedLine Citation:
PMID:  18033955     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Mortality studies in lacunar (LAC) stroke are scarce and often characterized by short follow-up time, small patient groups and absence of a nonlacunar stroke group for comparison. Besides, there are no separate long-term prognostic data on LAC stroke subtypes. We performed a long-term mortality study in LAC stroke, subtyping two distinct phenotypes and including nonlacunar ischemic stroke for comparison. METHODS: We performed cross-sectional follow-up, determining survival status, after a median of 15.0 years, in 333 first-ever atherothrombotic (AT), 184 cardioembolic (CE) and 265 LAC strokes, distinguishing LAC stroke with (type 2) or without (type 1) asymptomatic LAC lesions on CT. RESULTS: End of follow-up mortality (in 30-day survivors) in LAC stroke (76.2%) was significantly lower than in CE (87.1%; OR 0.48, 95% CI 0.27-0.84), but not AT strokes (79.0%; OR 0.85, 95% CI 0.57-1.26), and was significantly lower in LAC type 1 than type 2 strokes (70.9 vs. 87.5%; OR 0.35, 95% CI 0.17-0.73). Kaplan-Meier analysis showed most favorable survival in LAC type 1 stroke. In the Cox regression analyses, LAC type 1 stroke appeared as an independent predictor of better survival versus LAC type 2, versus AT and versus CE strokes. CONCLUSIONS: LAC stroke in general cannot be considered a 'benign' stroke type: only long-term survival in patients without concomitant asymptomatic LAC lesions is better than in large-vessel stroke. This difference in long-term survival between the two LAC stroke subtypes should be taken into account in prognostic counselling of individual LAC stroke patients.
Authors:
Julie Staals; Lisette van Raak; Anne Hilton; Jan Lodder
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Publication Detail:
Type:  Journal Article     Date:  2007-11-22
Journal Detail:
Title:  Cerebrovascular diseases (Basel, Switzerland)     Volume:  25     ISSN:  1421-9786     ISO Abbreviation:  Cerebrovasc. Dis.     Publication Date:  2008  
Date Detail:
Created Date:  2008-02-20     Completed Date:  2008-04-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9100851     Medline TA:  Cerebrovasc Dis     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  26-31     Citation Subset:  IM    
Copyright Information:
(c) 2007 S. Karger AG, Basel.
Affiliation:
Department of Neurology, University Hospital Maastricht, Maastricht, The Netherlands. j.staals@neurologie.azm.nl
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MeSH Terms
Descriptor/Qualifier:
Aged
Brain Infarction / diagnosis,  etiology,  mortality*
Case-Control Studies
Cross-Sectional Studies
Female
Follow-Up Studies
Humans
Leukoaraiosis / complications
Male
Survival Analysis
Survival Rate
Tomography, X-Ray Computed

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