A study of 229 people with mild ischemic stroke found that widening and elongation of arteries inside the skull—known as intracranial dolichoectasia—was strongly associated with lacunar stroke, a form of stroke tied to disease in the brain’s small vessels, while narrowing of major brain arteries was not.
Researchers followed 229 patients who had either a lacunar ischemic stroke or a mild non-lacunar ischemic stroke, using brain MRI soon after the event and again about a year later.
The study reported that intracranial dolichoectasia—arteries that are abnormally widened and elongated—was strongly associated with lacunar stroke. In the cohort, dolichoectasia was linked to substantially higher odds of lacunar stroke compared with non-lacunar stroke.
By contrast, the researchers found no comparable association between lacunar stroke and stenosis (narrowing) of larger intracranial arteries.
The study also found that new, clinically “silent” brain infarcts occurred during follow-up in a notable proportion of participants despite usual secondary-prevention care.
The findings add to evidence that lacunar stroke is primarily related to cerebral small-vessel disease rather than blockage from fatty plaque in larger arteries. Researchers involved in the work said the results may help explain why standard antiplatelet approaches used broadly after ischemic stroke have shown limited benefit for preventing recurrent lacunar stroke.
The research was published in Circulation and was funded by the UK Dementia Research Institute along with other organizations. Separate ongoing clinical research—including the Lacunar Intervention Trial 3 (LACI-3)—is testing whether drugs aimed at improving small-vessel function, such as cilostazol and isosorbide mononitrate, can improve outcomes after lacunar stroke.
