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Review
. 2022 Jan 28;23(3):1497.
doi: 10.3390/ijms23031497.

The Potential Impact of Neuroimaging and Translational Research on the Clinical Management of Lacunar Stroke

Salvatore Rudilosso  1 , Alejandro Rodríguez-Vázquez  1 , Xabier Urra  1 , Adrià Arboix  2
Affiliations
Review

The Potential Impact of Neuroimaging and Translational Research on the Clinical Management of Lacunar Stroke

Salvatore Rudilosso et al. Int J Mol Sci. .

Abstract

Lacunar infarcts represent one of the most frequent subtypes of ischemic strokes and may represent the first recognizable manifestation of a progressive disease of the small perforating arteries, capillaries, and venules of the brain, defined as cerebral small vessel disease. The pathophysiological mechanisms leading to a perforating artery occlusion are multiple and still not completely defined, due to spatial resolution issues in neuroimaging, sparsity of pathological studies, and lack of valid experimental models. Recent advances in the endovascular treatment of large vessel occlusion may have diverted attention from the management of patients with small vessel occlusions, often excluded from clinical trials of acute therapy and secondary prevention. However, patients with a lacunar stroke benefit from early diagnosis, reperfusion therapy, and secondary prevention measures. In addition, there are new developments in the knowledge of this entity that suggest potential benefits of thrombolysis in an extended time window in selected patients, as well as novel therapeutic approaches targeting different pathophysiological mechanisms involved in small vessel disease. This review offers a comprehensive update in lacunar stroke pathophysiology and clinical perspective for managing lacunar strokes, in light of the latest insights from imaging and translational studies.

Keywords: cerebrovascular disease; ischemic stroke; lacunar stroke; recent small subcortical infarcts; small vessel disease; stroke.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Historical evolution of the knowledge in lacunar strokes.
Figure 2
Figure 2
Histological–clinical–radiological correlations in lacunar strokes.
Figure 3
Figure 3
STandards for ReportIng Vascular changes on nEuroimaging (STRIVE) classification for ischemic lesions on MRI, produced by lacunar stroke.
See this image and copyright information in PMC

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