Impaired cerebrovascular reactivity as a risk marker for first-ever lacunar infarction: A case-control study

Stroke. 1999 Nov;30(11):2296-301. doi: 10.1161/01.str.30.11.2296.


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<0.0001, Student's 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<0.005), and the presence of lacunar infarction on magnetic resonance imaging (OR 5.3, P<0.001) as significant and independent factors associated with a reduction of CVR. Moreover, a cut-point of 55.6% (sensitivity 67%, specificity 82%) was established as the threshold value for distinguishing between pathological and normal CVR. CVR was significantly (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.

Publication types

  • Comparative Study

MeSH terms

  • Acetazolamide
  • Arterioles / diagnostic imaging
  • Arterioles / physiopathology
  • Blood Flow Velocity / physiology
  • Carbonic Anhydrase Inhibitors
  • Case-Control Studies
  • Cerebral Arteries / diagnostic imaging
  • Cerebral Arteries / physiopathology
  • Cerebral Infarction / diagnostic imaging
  • Cerebral Infarction / physiopathology*
  • Cerebrovascular Circulation / physiology*
  • Chi-Square Distribution
  • Confidence Intervals
  • Female
  • Forecasting
  • Hemodynamics / physiology
  • Humans
  • Hypertension / complications
  • Intracranial Arteriosclerosis / diagnosis
  • Intracranial Arteriosclerosis / physiopathology
  • Logistic Models
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Middle Cerebral Artery / diagnostic imaging
  • Middle Cerebral Artery / drug effects
  • Odds Ratio
  • Prospective Studies
  • Risk Factors
  • Sensitivity and Specificity
  • Sex Factors
  • Ultrasonography, Doppler, Transcranial


  • Carbonic Anhydrase Inhibitors
  • Acetazolamide