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Lacunar stroke: mechanisms and therapeutic implications
  1. Shadi Yaghi1,
  2. Eytan Raz2,
  3. Dixon Yang2,3,
  4. Shawna Cutting1,
  5. Brian Mac Grory4,
  6. Mitchell SV Elkind5,
  7. Adam de Havenon6
  1. 1Department of Neurology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
  2. 2Department of Radiology, NYU Langone Health, New York, New York, USA
  3. 3Department of Neurology, NYU Langone health, New York, New York, USA
  4. 4Department of Neurology, Duke Medicine, Durham, North Carolina, USA
  5. 5Department of Neurology, Columbia University Medical Center, New York, New York, USA
  6. 6Department of Neurology, University of Utah Hospital, Salt Lake City, Utah, USA
  1. Correspondence to Dr Shadi Yaghi, Department of Neurology, Brown University Warren Alpert Medical School, Providence, RI 02903, USA; shadiyaghi{at}


Lacunar stroke is a marker of cerebral small vessel disease and accounts for up to 25% of ischaemic stroke. In this narrative review, we provide an overview of potential lacunar stroke mechanisms and discuss therapeutic implications based on the underlying mechanism. For this paper, we reviewed the literature from important studies (randomised trials, exploratory comparative studies and case series) on lacunar stroke patients with a focus on more recent studies highlighting mechanisms and stroke prevention strategies in patients with lacunar stroke. These studies suggest that lacunar stroke is a heterogeneous disease with various mechanisms, including most commonly lipohyalinosis and less commonly atheromatous disease and cardioembolism, highlighting the importance of a careful review of brain and neurovascular imaging, a cardiac and systemic evaluation. A better understanding of pathomechanisms of neurological deterioration may lead to investigating the utility of novel treatment strategies and optimisation of short-term antithrombotic treatment strategies to reduce the risk of neurological deterioration and prevent long-term disability in patients with lacunar stroke.

  • stroke

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  • Contributors SY: manuscript preparation, revision, concept and design ER and AdH: manuscript preparation, revision and imaging acquisition. DY, BMG and SC: manuscript preparation and revision. MSVE: manuscript revision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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