Abstract Details

Title Imaging Versus Etiology: Lacunar or Non-Lacunar Stroke?

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P07 - (-)

Poster/Presentation
Number 230

Objective

Background BACKGROUND: Patients with non-lacunar stroke undergo more extensive testing aimed at discovering treatable causes of stroke not present in lacunar (small-vessel) stroke. TOAST criteria allow for classifying ischemic strokes based on clinical findings and the results of all ancillary testing into lacunar and non-lacunar (large-artery atherosclerosis, cardioembolism, stroke of other determined etiology and stroke of undetermined etiology). However, initial imaging findings of a lacunar stroke may be a deciding factor for a more limited diagnostic work-up that may fail to accurately diagnose a non-lacunar infarction. We investigated potential differences for diagnosing lacunar stroke between MRI imaging alone and TOAST criteria.

Design/Methods DESIGN/METHODS: Electronic records of 207 patients admitted for ischemic stroke and with MRI imaging evidence of infarction were evaluated. Patients were initially classified into lacunar and non-lacunar stroke based on MRI findings. TOAST criteria where then used to reclassify the same patients into lacunar and non-lacunar stroke. The proportion of lacunar strokes was compared between the two methods using McNemar's test, with significance set at 0.05.

Results RESULTS: Agreement between the MRI-based and TOAST criteria classifications was examined using positive and negative percent agreement, as well as Cohen's kappa (?). The agreement between the two methods was good, ? = 0.74, with an overall percent agreement of 89%. Negative percent agreement was excellent (100%), however, positive percent agreement was only 67%. The proportion of lacunar strokes as classified based on MRI findings was significantly different from the proportion using the TOAST criteria (MRI: 67 lacunar/140 non-lacunar versus TOAST: 45 lacunar/162 non-lacunar; p<0.0001).

Conclusions CONCLUSIONS: Approximately one third of lacunar strokes may have a different underlying etiology when using imaging alone. These results support using a comprehensive approach for diagnosing ischemic stroke subtype.

Authors/Disclosures
Anthony J. Vaughn, MD, FAAN (Mercy Health Center) PRESENTER	No disclosure on file
Andrea Vincent	Andrea Vincent has received personal compensation for serving as an employee of Vista LifeSciences. The institution of Andrea Vincent has received research support from Medical Technology Enterprise Consortium (MTEC).
Michael Strupp, MD, DO, FAAN (Hospital of the Ludwig Maximilians University, Munich, Dept of Neurology)	Dr. Strupp has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Vertify. Dr. Strupp has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for IntraBio. Dr. Strupp has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Vifor, Frisenius, CH. Dr. Strupp has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer. Dr. Strupp has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Frontiers. Dr. Strupp has stock in IntraBio.
Calin I. Prodan, MD (Univ of Oklahoma - Neurology Dept)	The institution of Dr. Prodan has received research support from US Department of Veterans Affairs (Merit award CX000340).

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