Impaired Cerebrovascular Reactivity as a Risk Marker for First-Ever Lacunar Infarction

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Abstract
Background and Purpose —Functional assessment of small arteries and arterioles could provide valuable information regarding the extent of diffuse arteriolosclerosis in patients with small-vessel disease. Therefore we attempted to clarify the role of cerebrovascular reactivity (CVR) as a risk marker for first-ever symptomatic lacunar infarction. Methods —Forty-six patients with lacunar infarction and 46 sex- and age-matched control subjects were prospectively evaluated. Cerebral hemodynamics were studied with transcranial Doppler ultrasonography. CVR was examined by calculating the percent increase in mean flow velocity occurring after 15 mg/kg acetazolamide administration (Diamox test). Results —CVR was significantly ( P t test) lower in cases (50.0±12.7%) as compared with control subjects (65.2±12.4%). A multiple logistic regression analysis identified male sex (odds ratio [OR] 2.3, P =0.02), age (OR 3.6, P P P =0.02) lower in patients with multiple (46.38±12.6%) than with single (54.83±11.58%) lacunar infarction. In addition, a trend of negative correlation was found between CVR and the number of lacunar infarctions ( r =−0.26, P =0.08). In the multiple logistic model, history of hypertension (OR 7.24; 95% confidence interval 2.95 to 17.79) and CVR (OR 0.8; 95% confidence interval 0.81 to 0.93) emerge as significant and independent predictors of first-ever lacunar infarction. Conclusions —These data suggest that impaired CVR is a risk marker for first-ever lacunar infarction.