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• W1044163640 abstract "Background. Lacunar strokes account for 25% of all ischaemic stroke but the exactnature of the causative cerebral small vessel abnormality remains unknown.Pathological studies are technically difficult and brain imaging cannot adequatelycharacterise the cerebral small vessels. The retinal blood vessels are of similar sizeand physiology to the cerebral small vessels and may act as a surrogate marker forthese cerebral small vessels. We therefore investigated retinal microvascularabnormalities in lacunar stroke.Methods. We performed a systematic review of retinal microvascular abnormalitiesin lacunar stroke to clarify associations and identify where further research wasrequired. We then established a cohort of patients presenting with lacunar strokewith cortical stroke controls to investigate differences in retinal microvascularabnormalities between stroke subtypes. All patients had MRI brain at presentationand digital retinal photography of both eyes. We investigated the prevalence ofretinopathy (hard and soft exudates or haemorrhages/microaneurysms), focalarteriolar narrowing and arteriovenous nicking . We developed, validated and usednovel semi-automated techniques for measuring retinal arteriolar and venular widths,retinal arteriolar geometry (branching co-efficients (change in arteriolar crosssectional area across a bifurcation) and branching angles) and fractal dimensions(reflecting branching complexity) of the vasculature. We also assessed MRIparameters in lacunar stroke. We used multivariable analysis to correct for baselineimbalances in vascular risk factors.Results. From the systematic review we demonstrated that retinal microvascularabnormalities are associated with incident and prevalent stroke but that in general,strokes were inadequately characterised and there were no data regarding retinalmicrovascular abnormalities in ischaemic stroke subtypes. We recruited 253patients, 129 lacunar strokes and 124 cortical strokes, mean age 68 years. We foundno difference in the prevalence of retinopathy, arteriovenous nicking, focal arteriolarnarrowing or arteriolar widths between lacunar and cortical stroke subtypes. Wefound that venules were wider in lacunar stroke. We found no differences inarteriolar branching co-efficients or arteriolar branching angles between lacunar andcortical strokes but found that deep white matter white matter hyperintensities onMRI were associated with increased branching co-efficients and periventricularwhite matter hyperintensities associated with decreased branching co-efficients. Wefound that the fractal dimension of the vascular tree was decreased in lacunar stroke.Furthermore we found that enlarged perivascular spaces on MRI are associated withlacunar stroke and white matter disease.Conclusions. We have clearly demonstrated that retinal microvascular abnormalitiesdiffer between lacunar and cortical stroke suggesting that a distinct small vesselvasculopathy may cause lacunar stroke. We have also identified MR markers oflacunar stroke. These results suggest that venular disease (a hitherto underresearchedarea) may play a role in the pathophysiology of lacunar stroke. Retinalmicrovascular abnormalities can act as markers for cerebral small vessel disease. Weplan collaborative analyses with colleagues who have performed similar studies tofurther assess retinal abnormalities in lacunar stroke." @default.
• W1044163640 created "2016-06-24" @default.
• W1044163640 creator A5015592473 @default.
• W1044163640 date "2011-07-05" @default.
• W1044163640 modified "2023-09-24" @default.
• W1044163640 title "Do retinal microvascular abnormalities shed light on the pathophysiology of lacunar stroke" @default.
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