摘要：To asses the therapeutic strategy for
secondary prevention in lacunar stroke, according to the underlying mechanism of
the cerebral infarct and to determine the recurrence rate of ischemic stroke in
patients with lacunar infarct.
Lacunar stroke is a small cerebral infarct in the territory of a single
perforator artery. The mechanisms that underlie lacunar infarct are various:
small vessel disease, atherothrombotic, cardiac and artery-to-artery embolism.
Material and methods . The study was performed in 1083 patients with
lacunar stroke admitted in Ist Clinic of Neurology, “Saint Trinity”
Hospital, Iaşi, during 1.01.1999 - 30.12.2004. The most probable underlying
mechanism for the lacunar stroke has been established for each case. A certain
therapeutic strategy has been applied for secondary prevention. Results and
discussion. 163 patients with hypertension have a lacunar stroke due to
small vessel disease and the other 489 hypertensive patients had an
atherothrombotic lacunar stroke. 219 patients had a probable cardioembolic
lacunar stroke. In 94 patients the lacunar stroke was probable due to an artery
- to - artery embolism. Aspirin 250 mg was given immediately in 1029 patients
and continued for 14 days before changing the patient to a maintenance dose of
75 mg daily for secondary prevention. Clopidogrel 75 mg/day was the option in 54 patients. Anticoagulant therapy was
used for selected cases of cardioembolic lacunar stroke. 59 patients (5.5%) had
a recurrent stroke. Conclusions. The drugs used for acute treatment and
for secondary prevention in lacunar stroke must be similar to that used for any
other types of ischemic stroke. A high proportion of patients have a recurrent
lacunar stroke .
