SIGNIFICANT PROGRESSION OF WHITE-MATTER LESIONS AND SMALL DEEP (LACUNAR) INFARCTS IN PATIENTS WITH STROKE

Objectives: To investigate whether the extent of white matter lessons (WMLs) and the number of small deep infarcts and territorial infarcts progress over time in patients with stroke and to test the hypothesis that WMLs are associated with small deep infarcts. Design: Computed to mographic follow-up study in a cohort of 107 patients with ischemic st roke (median follow-up, 3.0 years). getting: Primary and referral care center. Patients: Sixty-three of 144 registered patients with a first -ever symptomatic lacunar stroke and 44 of 155 with a territorial stro ke entered this study. Forty-seven (33%) of the the nonparticipating p atients with a lacunar stroke and 54 (35%) of those with a territorial stroke died, and 34 (23%) and 57 (37%), respectively, refused compute d tomographic follow-up. Main Outcome Measures: The extent of the WMLs and the number of small deep and territorial infarcts on computed tom ographic scans at study entry and at follow-up. Results: Progression o f WMLs occurred in 26 patients (26%), and multivariate regression anal ysis showed that it was associated with symptomatic lacunar stroke at study entry (adjusted odds ratio [aOR], 5.0; 95% confidence interval [ CI], 1.2-20.3), silent small deep infarcts at study entry (aOR, 6.0; 9 5% CI, 1.0-34.6), old age (aOR, 5.5; 95% CI, 1.3-23.1), and longer fol low-up (aOR, 12.7; 95% CI, 1.8-89.0). We found progression of small de ep infarcts in 41 patients (38%). The progression was associated with symptomatic lacunar stroke at study entry (aOR, 27.7; 95% CI, 6.3-120. 9) and longer follow-up (aOR, 7.7; 95% CI, 1.4-41.3). Progression of b oth WMLs and small deep infarcts, which occurred in 16 patients (16%), was associated with symptomatic lacunar stroke al study entry (aOR, 3 4.1; 95% CI, 2.5-471.7), silent small deep infarcts at study entry (aO R, 12.5; 95% CI, 1.4-112.0), and longer follow-up (aOR, 29.7; 95% CI, 1.8-501.0). The number of territorial infarcts increased in 14 patient s (13%). The increase was associated with symptomatic territorial stro ke at study entry (aOR, 7.9; 95% CI, 1.5-40.8) and a history of ischem ic heart disease (aOR, 6.6; 95% CI, 1.3-34.8). Conclusions: The marked progression of WMLs and small deep infarcts that occurred mainly in p atients with lacunar stroke suggests that both WMLs and small deep (la cunar) infarcts are caused by a similar vasculopathy that affects smal l vessels, which is progressive despite standard stroke treatment.