{
  "schemaVersion": 2,
  "eyebrow": "Vascular Neurology",
  "title": "Lacunar Stroke",
  "summary": "Manage suspected lacunar stroke as an acute ischemic stroke while confirming the mechanism with diffusion MRI and vascular-cardioembolic evaluation. Long-term decisions hinge on distinguishing true small-vessel disease from parent-artery, embolic, or incidental infarction and avoiding harmful chronic dual antiplatelet therapy.",
  "seoDescription": "Point-of-care approach to acute evaluation, mechanism confirmation, antithrombotic selection, blood pressure control, and secondary prevention after lacunar stroke.",
  "clinicalQuestion": "How should physicians confirm lacunar stroke, exclude competing mechanisms, and select acute and long-term secondary prevention?",
  "specialty": "Neurology",
  "audience": "U.S. physicians and medical trainees",
  "tags": [
    "lacunar infarction",
    "small vessel stroke",
    "penetrating artery stroke",
    "SPS3",
    "secondary stroke prevention"
  ],
  "keyTakeaways": [
    "Do not withhold acute ischemic stroke reperfusion treatment because a syndrome appears lacunar; intravenous thrombolysis is recommended using standard acute ischemic stroke criteria. [7][10]",
    "A classic lacunar syndrome without cortical dysfunction supports small-vessel occlusion, but ipsilateral extracranial stenosis greater than 50% or a cardiac embolic source argues against assigning a small-vessel mechanism. [12]",
    "Use MRI with diffusion-weighted imaging when available to detect acute small deep or brainstem infarcts that noncontrast CT can miss. [15]",
    "For confirmed symptomatic lacunar infarction, use long-term single antiplatelet therapy rather than chronic aspirin-clopidogrel therapy; SPS3 found no recurrent-stroke benefit and increased death with long-term dual therapy. [7][8][17]",
    "Control blood pressure and lipids as secondary prevention; across target-based poststroke trials, lower blood-pressure targets reduced recurrent stroke by 22% without demonstrated harm, although the optimal low threshold for every subgroup remains uncertain. [6][7]"
  ],
  "sections": [
    {
      "id": "acute-triage",
      "eyebrow": "Immediate Management",
      "heading": "Treat the acute presentation as ischemic stroke until imaging and mechanism establish otherwise",
      "intro": "A presumed lacunar syndrome does not justify a lower-acuity pathway.",
      "paragraphs": [
        "Activate the acute stroke pathway for sudden focal deficits, obtain urgent brain imaging to exclude hemorrhage, and assess eligibility for intravenous thrombolysis under the institution's acute ischemic stroke protocol. Guidelines for lacunar ischemic stroke recommend intravenous alteplase, antiplatelet treatment, and avoidance of acute blood-pressure lowering according to general acute ischemic stroke guidance rather than lacunar-specific exclusions. [7][10]",
        "Noncontrast CT is fast and broadly available but has limited sensitivity for very early ischemia and for brainstem or lacunar infarcts. Obtain MRI with diffusion-weighted imaging when the diagnosis remains uncertain, when posterior circulation or small deep infarction is suspected, or when confirmation will change etiologic attribution; diffusion MRI is more sensitive for acute ischemia. [15]",
        "Do not label an acute deficit “lacunar” solely from a pure motor, pure sensory, ataxic hemiparesis, or dysarthria-clumsy hand phenotype. These syndromes support a subcortical localization, but penetrating-artery territory infarction can result from lipohyalinosis, microatheroma at the parent-artery branch ostium, embolism, or large-vessel disease. [11][13]"
      ],
      "bullets": [
        "Prioritize MRI confirmation when CT is unrevealing but the clinical syndrome remains focal and disabling. [15]",
        "Avoid routine acute blood-pressure reduction solely because the suspected mechanism is small-vessel disease; follow the acute ischemic stroke protocol. [7]",
        "Initiate rehabilitation assessment during hospitalization when motor, gait, speech, or functional deficits persist. [11][13]"
      ],
      "subsections": [],
      "table": {
        "caption": "Acute decisions in suspected lacunar stroke. [7][10][15]",
        "columns": [
          "Clinical situation",
          "Action",
          "Decision implication"
        ],
        "rows": [
          [
            "New focal deficit with possible reperfusion eligibility",
            "Obtain immediate brain imaging and manage through an acute stroke service. [16]",
            "Do not exclude intravenous thrombolysis because the presentation seems lacunar. [7][10]"
          ],
          [
            "Negative or nondiagnostic CT with suspected small deep or brainstem infarct",
            "Obtain diffusion-weighted MRI when feasible without disrupting time-sensitive acute care. [15]",
            "MRI increases detection of acute ischemia in locations where CT is relatively insensitive. [15]"
          ],
          [
            "Confirmed acute symptomatic lacunar infarct",
            "Transition to mechanism-directed secondary prevention after acute treatment. [7]",
            "Long-term antithrombotic strategy depends on whether the mechanism remains noncardioembolic small-vessel disease. [7][12]"
          ]
        ]
      }
    },
    {
      "id": "confirm-mechanism",
      "eyebrow": "Diagnostic Attribution",
      "heading": "Confirm small-vessel occlusion before committing to a lacunar prevention strategy",
      "intro": "The imaging lesion, cortical examination, vascular findings, and cardiac evaluation must align.",
      "paragraphs": [
        "A working small-vessel occlusion diagnosis requires a compatible lacunar syndrome without cortical dysfunction and either normal neuroimaging or a relevant subcortical or brainstem lesion smaller than 1.5 cm. Hypertension or diabetes supports this mechanism, but neither risk factor establishes it. [12]",
        "Reclassify the event away from isolated small-vessel occlusion when there is a cardiac embolic source or ipsilateral major extracranial arterial stenosis greater than 50%. This distinction is consequential because embolic disease may require anticoagulation for its underlying indication, whereas anticoagulants are not used for recurrent stroke prevention in cerebral small-vessel disease itself because of disproportionate intracranial hemorrhage risk. [11][12]",
        "Evaluate the infarct in an anatomic context. Lipohyalinosis causes concentric hyaline thickening and occlusion of small cerebral vessels, whereas microatheroma or parent-artery plaque can obstruct the perforator origin. A deep infarct therefore warrants review of relevant large-vessel imaging and cardiac-source assessment even when the clinical syndrome is classically lacunar. [11][13]",
        "When MRI is obtained, document whether the lesion is acute on diffusion imaging and whether its location matches the deficit. Follow-up T1-weighted MRI at 90 days shows cavitation in nearly all acute lacunar infarctions, but this is a radiographic evolution marker rather than a requirement for acute diagnosis or treatment. [3]"
      ],
      "bullets": [
        "Cortical dysfunction should trigger reconsideration of the presumed mechanism and review for embolic or large-vessel disease. [12]",
        "An ipsilateral extracranial stenosis greater than 50% is incompatible with a straightforward small-vessel occlusion classification. [12]",
        "A cardiac embolic source should redirect secondary prevention toward the identified cause rather than empiric small-vessel anticoagulation. [11][12]"
      ],
      "subsections": [],
      "table": {
        "caption": "Features that support or challenge a small-vessel occlusion attribution. [11][12][13]",
        "columns": [
          "Finding",
          "Mechanistic interpretation",
          "Next action"
        ],
        "rows": [
          [
            "Classic lacunar syndrome with no cortical dysfunction",
            "Supports a subcortical small-vessel phenotype. [12]",
            "Correlate with CT or MRI and complete vascular-cardiac assessment. [12]"
          ],
          [
            "Relevant subcortical or brainstem lesion smaller than 1.5 cm",
            "Supports small-vessel occlusion when clinical and exclusion criteria also fit. [12]",
            "Use as one component of etiologic classification. [12]"
          ],
          [
            "Cardiac embolic source",
            "Challenges a primary small-vessel attribution. [12][13]",
            "Treat the identified cardioembolic mechanism; do not use anticoagulation solely for lacunar disease. [11]"
          ],
          [
            "Ipsilateral extracranial arterial stenosis greater than 50%",
            "Challenges small-vessel occlusion classification. [12]",
            "Pursue large-artery mechanism assessment and management. [12]"
          ],
          [
            "Hypertension or diabetes",
            "Raises pretest probability of cerebral small-vessel disease but is not diagnostic. [12][21]",
            "Maintain a complete mechanism evaluation. [12]"
          ]
        ]
      }
    },
    {
      "id": "antithrombotic-strategy",
      "eyebrow": "Secondary Prevention",
      "heading": "Use single antiplatelet therapy long term for confirmed symptomatic lacunar stroke",
      "intro": "Chronic dual antiplatelet therapy is harmful in this population.",
      "paragraphs": [
        "For symptomatic lacunar infarction attributed to small-vessel disease, prescribe a single antiplatelet agent for long-term secondary prevention. This is the standard approach in AHA/ASA-aligned care and is recommended in the ESO lacunar stroke guideline. [7][9][17]",
        "Do not continue aspirin plus clopidogrel as chronic secondary prevention after lacunar stroke. In SPS3, dual versus single antiplatelet treatment over a mean 3.4 years did not prevent recurrent stroke or cognitive decline and increased death; the trial was stopped early for harm. [7][8][23]",
        "Short, early dual antiplatelet therapy has a separate evidence base for high-risk noncardioembolic TIA, where trials started treatment within 24 hours and found the most favorable benefit-risk balance with 10 to 21 days of therapy. Do not extrapolate that short-course TIA strategy into indefinite aspirin-clopidogrel treatment for MRI-confirmed lacunar stroke. [24]",
        "Do not initiate antiplatelet therapy solely because imaging shows an incidental silent lacunar infarct in a person without prior symptomatic stroke. ESO guidance for covert cerebral small-vessel disease does not recommend antiplatelets for incidental lacunar infarcts because clinical trial evidence is insufficient and low quality. [8][9]"
      ],
      "bullets": [
        "Confirmed symptomatic small-vessel infarct: long-term single antiplatelet therapy. [7][17]",
        "Chronic aspirin plus clopidogrel after lacunar stroke: avoid because SPS3 found harm without recurrent-stroke benefit. [7][8]",
        "Incidental silent lacune: manage vascular risk factors; do not treat the imaging finding itself with routine antiplatelet therapy. [8][9]"
      ],
      "subsections": [],
      "table": {
        "caption": "Antithrombotic selection by clinical context. [7][8][9][11][24]",
        "columns": [
          "Clinical context",
          "Preferred strategy",
          "Avoid or qualify"
        ],
        "rows": [
          [
            "Symptomatic lacunar infarction attributed to small-vessel disease",
            "Long-term single antiplatelet therapy. [7][17]",
            "Avoid chronic aspirin-clopidogrel therapy. [7][8]"
          ],
          [
            "High-risk noncardioembolic TIA evaluated early",
            "Consider early, time-limited dual antiplatelet therapy; evidence supports initiation within 24 hours and 10 to 21 days of treatment. [24]",
            "This does not support indefinite dual therapy after lacunar infarction. [24]"
          ],
          [
            "Incidental silent lacunar infarct without prior stroke",
            "Address vascular risk factors. [9]",
            "Do not routinely prescribe antiplatelet therapy for the incidental lesion. [8][9]"
          ],
          [
            "Established cardiac embolic mechanism",
            "Use cause-directed antithrombotic management. [11][12]",
            "Do not anticoagulate solely for cerebral small-vessel disease. [11]"
          ]
        ]
      }
    },
    {
      "id": "risk-factor-control",
      "eyebrow": "Vascular Prevention",
      "heading": "Prioritize sustained blood-pressure control, lipid lowering, and functional recovery",
      "intro": "Risk-factor control is the principal disease-modifying strategy once the acute phase has passed.",
      "paragraphs": [
        "Institute long-term blood-pressure control after the acute stroke period. In a meta-analysis of target-based intensive versus standard blood-pressure trials after stroke, lower targets reduced recurrent stroke by 22% (hazard ratio 0.78; 95% CI 0.64-0.96) without evidence of harm. However, the evidence was driven predominantly by RESPECT, and the lowest systolic pressure that may be unsafe in susceptible subgroups remains undefined. [6]",
        "For recent lacunar stroke specifically, SPS3 compared systolic targets of 130 to 149 mm Hg versus a lower target, but intensive blood-pressure lowering did not clearly reduce recurrent stroke or prevent cognitive decline in the lacunar-specific guideline assessment. Use individualized antihypertensive treatment with attention to symptoms and comorbidity rather than assuming that an arbitrarily low systolic target is universally beneficial. [4][7]",
        "Use lipid-lowering therapy according to current secondary stroke prevention guidance. In SPARCL post hoc data, statin efficacy in patients with lacunar infarction was similar to the overall trial cohort; among patients with baseline small-vessel disease, hemorrhagic stroke increased but ischemic stroke decreased, yielding an overall benefit similar to the trial population. [7][10]",
        "Address smoking, exercise, healthy lifestyle measures, and obesity as part of secondary prevention. Monitor for cognitive decline, gait or mobility impairment, and mood symptoms, which are clinically relevant manifestations of cerebral small-vessel disease and may determine rehabilitation and longitudinal care needs. [7]"
      ],
      "bullets": [
        "Begin or intensify long-term antihypertensive therapy after the acute phase; monitor for intolerance when pursuing lower pressures. [6][7]",
        "Use lipid lowering according to secondary stroke prevention guidance, recognizing the ischemic-versus-hemorrhagic tradeoff in extensive small-vessel disease. [7][10]",
        "Arrange physical and occupational rehabilitation when residual deficits limit independence. [11][13]"
      ],
      "subsections": [
        {
          "heading": "Incidental versus symptomatic disease",
          "paragraphs": [
            "Separate a covert lacune from a clinical ischemic stroke at every follow-up visit. A symptomatic lacunar infarct warrants secondary stroke prevention with single antiplatelet therapy, blood-pressure control, lipid lowering, and lifestyle measures; an incidental lesion does not by itself establish an antiplatelet indication. [7][8][9]"
          ],
          "bullets": []
        }
      ],
      "table": {
        "caption": "Long-term monitoring priorities after symptomatic lacunar stroke. [6][7][10][11]",
        "columns": [
          "Domain",
          "What to monitor",
          "Action if abnormal"
        ],
        "rows": [
          [
            "Blood pressure",
            "Long-term achieved pressure and symptoms during treatment intensification. [6][7]",
            "Adjust antihypertensive therapy to sustain control while avoiding clinically important intolerance. [6][7]"
          ],
          [
            "Lipids",
            "Adherence and response to lipid-lowering therapy. [7][10]",
            "Continue guideline-directed lipid lowering for secondary prevention. [7][10]"
          ],
          [
            "Neurologic function",
            "Mobility, gait, activities of daily living, and focal deficits. [7][11]",
            "Refer for or intensify multidisciplinary rehabilitation. [11][13]"
          ],
          [
            "Cognition and mood",
            "Cognitive decline and mood symptoms associated with cerebral small-vessel disease. [7]",
            "Perform targeted assessment and incorporate findings into longitudinal care planning. [7]"
          ]
        ]
      }
    },
    {
      "id": "follow-up-reclassification",
      "eyebrow": "Follow-up",
      "heading": "Reassess mechanism when recurrence or imaging patterns do not fit a single perforator infarct",
      "intro": "Recurrence should prompt etiologic reconsideration rather than automatic escalation of antiplatelet therapy.",
      "paragraphs": [
        "For recurrent ischemic events despite apparent lacunar disease, repeat the etiologic review for a cardiac embolic source, relevant extracranial stenosis, and lesion-clinical mismatch. The original small-vessel designation is only probable when clinical findings, imaging, and diagnostic studies are concordant and competing causes have been excluded. [12]",
        "Do not respond to recurrence by adding indefinite aspirin-clopidogrel therapy without a separate indication. SPS3 provides direct evidence that chronic dual antiplatelet treatment after lacunar stroke increases mortality without preventing recurrent stroke. [7][8][23]",
        "If follow-up MRI demonstrates a cavity at approximately 90 days, interpret this as expected evolution of an acute lacunar infarct rather than treatment failure. New diffusion-positive lesions or a cortical pattern, by contrast, should reopen the mechanism assessment. [3][12]"
      ],
      "bullets": [
        "New cortical deficits or cortical infarction pattern: revisit embolic and large-vessel causes. [12]",
        "Recurrent event with no new mechanism identified: optimize blood pressure, lipid lowering, lifestyle intervention, and adherence rather than defaulting to chronic dual antiplatelet therapy. [6][7][8]",
        "Persistent disability: reassess rehabilitation needs rather than assuming neurologic recovery is complete at discharge. [11][13]"
      ],
      "subsections": [],
      "table": {
        "caption": "Findings that should trigger reclassification during follow-up. [3][7][8][12]",
        "columns": [
          "Follow-up finding",
          "Interpretation",
          "Next step"
        ],
        "rows": [
          [
            "New cortical dysfunction",
            "Not typical of an uncomplicated lacunar syndrome. [12]",
            "Reevaluate for large-vessel or cardioembolic mechanism. [12]"
          ],
          [
            "New cardiac embolic source or ipsilateral stenosis greater than 50%",
            "Competing cause supersedes a simple small-vessel designation. [12]",
            "Shift to cause-directed secondary prevention. [11][12]"
          ],
          [
            "T1 cavitation at 90 days",
            "Expected evolution in nearly all acute lacunar infarctions. [3]",
            "Do not interpret cavitation alone as recurrent infarction. [3]"
          ],
          [
            "Recurrent ischemic stroke",
            "Requires mechanism reassessment and risk-factor optimization. [6][12]",
            "Do not add chronic dual antiplatelet therapy solely because of recurrence. [7][8]"
          ]
        ]
      }
    }
  ],
  "faq": [],
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  ],
  "editorialNote": "Prepared from cited clinical literature using Astra's research workflow. Verify recommendations against current guidance and patient-specific factors.",
  "citations": [
    {
      "number": 1,
      "title": "The Lancet Specialty Collections: Hypertension",
      "detail": "www.thelancet.com",
      "url": "https://www.thelancet.com/collections/lancet-hypertension?parent=001536&startPage=5&ContentItemType=fla&pageSize=25",
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      "snippet": "... controlled ... Effects of long-term blood pressure lowering and dual antiplatelet treatment ... lacunar stroke: a secondary analysis from the SPS3 randomised trial.",
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    {
      "number": 2,
      "title": "Blood-pressure targets in patients with recent lacunar stroke",
      "detail": "www.thelancet.com",
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      "snippet": "In the Secondary Prevention of Small Subcortical Strokes (SPS3) trial we tested two interventions in patients with recent, symptomatic, MRI-confirmed lacunar",
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      "title": "Cavitation After Acute Symptomatic Lacunar Stroke ...",
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      "authors": "www.ahajournals.org",
      "host": "www.ahajournals.org",
      "snippet": "by F Moreau · 2012 · Cited by 153 — MRI scanning at 90 days with T1-weighted imaging reveals evidence of cavitation in nearly all cases of acute lacunar infarction.",
      "score": 0.35837606
    },
    {
      "number": 4,
      "title": "Optimum Blood Pressure Target After Lacunar Stroke",
      "detail": "www.ahajournals.org",
      "url": "https://www.ahajournals.org/doi/10.1161/hypertensionaha.113.02503",
      "authors": "www.ahajournals.org",
      "host": "www.ahajournals.org",
      "snippet": "by GJ Hankey · 2014 · Cited by 7 — BP is not known. Hence, guidelines state “an absolute target … to a higher systolic BP target of 130 to 149 mm Hg (n=1510) or to a lower",
      "score": 0.4556594
    },
    {
      "number": 5,
      "title": "New Insights Into Cerebrovascular Pathophysiology and ...",
      "detail": "www.ahajournals.org",
      "url": "https://www.ahajournals.org/doi/10.1161/STROKEAHA.121.035850",
      "authors": "www.ahajournals.org",
      "host": "www.ahajournals.org",
      "snippet": "Recurrent stroke was reduced in patients with lacunar events in the SPS3 trial (Secondary Prevention of Small Subcortical Strokes), while",
      "score": 0.6682966
    },
    {
      "number": 6,
      "title": "Long-Term Secondary Prevention: Management of Blood ...",
      "detail": "www.ahajournals.org",
      "url": "https://www.ahajournals.org/doi/10.1161/STROKEAHA.121.035851",
      "authors": "www.ahajournals.org",
      "host": "www.ahajournals.org",
      "snippet": "Crossref\n\nPubMed\n\nGoogle Scholar\n\n27.\n\nKitagawa K, Yamamoto Y, Arima H, Maeda T, Sunami N, Kanzawa T, Eguchi K, Kamiyama K, Minematsu K, Ueda S, et al; Recurrent Stroke Prevention Clinical Outcome (RESPECT) Study Group. Effect of Standard vs Intensive Blood Pressure Control on the Risk of Recurrent ",
      "score": 0.657033
    },
    {
      "number": 7,
      "title": "European stroke organisation (ESO) guideline on cerebral small vessel disease, part 2, lacunar ischaemic stroke",
      "detail": "pmc.ncbi.nlm.nih.gov",
      "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10916806",
      "authors": "pmc.ncbi.nlm.nih.gov",
      "host": "pmc.ncbi.nlm.nih.gov",
      "snippet": "cognitive decline, mobility, gait, or mood disorders. We systematically reviewed the literature, assessed the evidence and where feasible formulated evidence-based recommendations, and expert concensus statements. We found little direct evidence, mostly of low quality. We recommend that patients wit",
      "score": 0.7946564
    },
    {
      "number": 8,
      "title": "ESO Guideline on covert cerebral small vessel disease - PMC",
      "detail": "pmc.ncbi.nlm.nih.gov",
      "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC8370079",
      "authors": "pmc.ncbi.nlm.nih.gov",
      "host": "pmc.ncbi.nlm.nih.gov",
      "snippet": "Stroke presentations of SVD such as ‘lacunar’ stroke or ICH, are included within current regional or national stroke guidelines85,86 and situations with clinically clear manifestations of SVD were outside the scope of the current guideline. Monogenic forms of SVD were addressed recently.9 A previous",
      "score": 0.7062922
    },
    {
      "number": 9,
      "title": "Controversies in stroke: Antiplatelet therapy or not for asymptomatic/incidental lacunar infarction",
      "detail": "pmc.ncbi.nlm.nih.gov",
      "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10421561",
      "authors": "pmc.ncbi.nlm.nih.gov",
      "host": "pmc.ncbi.nlm.nih.gov",
      "snippet": "The current standard of care for secondary stroke prevention in patients with symptomatic lacunar infarcts attributed to small vessel disease is initiation of antiplatelet therapy, as recommended by the AHA/ASA.52 However, there is currently no standard of care for secondary prevention in patients w",
      "score": 0.6565047
    },
    {
      "number": 10,
      "title": "Prevention and Management of Cerebral Small Vessel Disease",
      "detail": "pmc.ncbi.nlm.nih.gov",
      "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC4460330",
      "authors": "pmc.ncbi.nlm.nih.gov",
      "host": "pmc.ncbi.nlm.nih.gov",
      "snippet": "but are at an increased risk of bleeding, the efficacy of statins has been questioned in patients with lacunar infarction. However, in the SPARCL trial, 1,409 patients had lacunar infarction, and post-hoc analysis showed that the efficacy of statins was similar in this group.85 Although there was an",
      "score": 0.5962692
    },
    {
      "number": 11,
      "title": "Lacunar Stroke - StatPearls - NCBI Bookshelf",
      "detail": "www.ncbi.nlm.nih.gov",
      "url": "https://www.ncbi.nlm.nih.gov/books/NBK563216",
      "authors": "www.ncbi.nlm.nih.gov",
      "host": "www.ncbi.nlm.nih.gov",
      "snippet": "Lacunar stroke represents a common manifestation of cerebral small vessel disease and accounts for a substantial proportion of ischemic strokes affecting deep subcortical brain structures. This course reviews these small, noncortical infarcts resulting from occlusion of penetrating end arteries due ",
      "score": 0.5820878
    },
    {
      "number": 12,
      "title": "Ischemic Stroke - StatPearls - NCBI Bookshelf - NIH",
      "detail": "www.ncbi.nlm.nih.gov",
      "url": "https://www.ncbi.nlm.nih.gov/books/NBK499997",
      "authors": "www.ncbi.nlm.nih.gov",
      "host": "www.ncbi.nlm.nih.gov",
      "snippet": "Small Vessel Occlusion\n\nThis category includes patients with strokes typically classified as lacunar infarcts in other classification systems. These patients should present with one of the classic lacunar syndromes and should not exhibit signs of cerebral cortical dysfunction. Please see StatPearls'",
      "score": 0.41634628
    },
    {
      "number": 13,
      "title": "Acute Stroke - StatPearls - NCBI Bookshelf - NIH",
      "detail": "www.ncbi.nlm.nih.gov",
      "url": "https://www.ncbi.nlm.nih.gov/books/NBK535369",
      "authors": "www.ncbi.nlm.nih.gov",
      "host": "www.ncbi.nlm.nih.gov",
      "snippet": "Clinical guidelines for ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage advocate for interprofessional healthcare teams in prehospital and hospital settings to enhance patient outcomes. A multidisciplinary team provides rehabilitation services during and after hospitalization ",
      "score": 0.41392776
    },
    {
      "number": 14,
      "title": "Cryptogenic stroke: definitions and management",
      "detail": "ashpublications.org",
      "url": "https://ashpublications.org/hematology/article/2025/1/15/556852/Cryptogenic-stroke-definitions-and-management",
      "authors": "ashpublications.org",
      "host": "ashpublications.org",
      "snippet": "Patients with cryptogenic stroke/ESUS should be treated with aspirin and aggressive atherosclerosis risk factor management. Learning Objectives:.",
      "score": 0.065995164
    },
    {
      "number": 15,
      "title": "Stroke and Stroke Mimics: Diagnosis and Treatment - Diseases of the Brain, Head and Neck, Spine 2020–2023 - NCBI Bookshelf",
      "detail": "www.ncbi.nlm.nih.gov",
      "url": "https://www.ncbi.nlm.nih.gov/books/NBK554340",
      "authors": "www.ncbi.nlm.nih.gov",
      "host": "www.ncbi.nlm.nih.gov",
      "snippet": "Each modality has its advantages and disadvantages. CT is favored in most institutions world-wide due to widespread availability, inherently rapid imaging, relatively lower cost, and comfort level for referring providers and interpreting physicians; the only major potential disadvantages are radiati",
      "score": 0.3355473
    },
    {
      "number": 16,
      "title": "Stroke and transient ischaemic attack in over 16s: ...",
      "detail": "www.nice.org.uk",
      "url": "https://www.nice.org.uk/guidance/ng128/chapter/recommendations",
      "authors": "www.nice.org.uk",
      "host": "www.nice.org.uk",
      "snippet": "##### 1.4.3\n\nStaff in emergency departments, if appropriately trained and supported, can administer alteplase or tenecteplase for the treatment of ischaemic stroke provided that patients can be managed within an acute stroke service with appropriate neuroradiological and stroke physician support. [2",
      "score": 0.3059777
    },
    {
      "number": 17,
      "title": "Clinical Relevance of Cerebral Small Vessel Diseases",
      "detail": "www.ahajournals.org",
      "url": "https://www.ahajournals.org/doi/10.1161/STROKEAHA.119.024148",
      "authors": "www.ahajournals.org",
      "host": "www.ahajournals.org",
      "snippet": "by M Pasi · 2020 · Cited by 178 — Currently, antiplatelet monotherapy is recommended to prevent recurrent strokes after lacunar strokes because dual antiplatelet therapy might",
      "score": 0.6562404
    },
    {
      "number": 18,
      "title": "Cerebral Small Vessel Disease–Related Dementia",
      "detail": "www.ahajournals.org",
      "url": "https://www.ahajournals.org/doi/10.1161/STROKEAHA.122.038265",
      "authors": "www.ahajournals.org",
      "host": "www.ahajournals.org",
      "snippet": "by FM Elahi · 2023 · Cited by 96 — Blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomised trial. Lancet. 2013;382:507–515. doi: 10.1016/S0140-6736",
      "score": 0.5596998
    },
    {
      "number": 19,
      "title": "2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/ ...",
      "detail": "www.ahajournals.org",
      "url": "https://www.ahajournals.org/doi/10.1161/hyp.0000000000000065",
      "authors": "www.ahajournals.org",
      "host": "www.ahajournals.org",
      "snippet": "Crossref\n\nPubMed\n\nGoogle Scholar\n\nS8.1.5-15.\n\nWright JT, Williamson JD, Whelton PK, et al. A randomized trial of intensive versus standard blood-pressure control. SPRINT Research Group. _N Engl J Med_. 2015;_373_:2103–16.\n\nCrossref\n\nPubMed\n\nGoogle Scholar\n\nS8.1.5-16.\n\nSPS3 Study Group. Blood-pressur",
      "score": 0.5568099
    },
    {
      "number": 20,
      "title": "2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ ...",
      "detail": "www.ahajournals.org",
      "url": "https://www.ahajournals.org/doi/10.1161/CIR.0000000000001356",
      "authors": "www.ahajournals.org",
      "host": "www.ahajournals.org",
      "snippet": "by Writing Committee Members* · 2025 · Cited by 773 — The SPS3 Study Group. Blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomised trial. prevention, detection, evaluation, A randomized",
      "score": 0.51105833
    },
    {
      "number": 21,
      "title": "Lacunar Strokes in Patients With Diabetes Mellitus",
      "detail": "www.ahajournals.org",
      "url": "https://www.ahajournals.org/doi/10.1161/strokeaha.114.005018",
      "authors": "www.ahajournals.org",
      "host": "www.ahajournals.org",
      "snippet": "Results— Among the <0.001), the risk of lacunar stroke was 2× higher in patients with diabetes mellitus compared with age and sex-matched controls.4. SPS3",
      "score": 0.41606155
    },
    {
      "number": 22,
      "title": "Current and Future Treatments of Vascular Cognitive ...",
      "detail": "www.ahajournals.org",
      "url": "https://www.ahajournals.org/doi/10.1161/STROKEAHA.123.044174?doi=10.1161%2FSTROKEAHA.123.044174",
      "authors": "www.ahajournals.org",
      "host": "www.ahajournals.org",
      "snippet": "PRESERVE: randomized trial of intensive versus standard blood pressure control in small vessel disease. Stroke. 2021;52:2484–2493. doi",
      "score": 0.38505143
    },
    {
      "number": 23,
      "title": "Predictors of Mortality in Patients With Lacunar Stroke ...",
      "detail": "www.ahajournals.org",
      "url": "https://www.ahajournals.org/doi/10.1161/strokeaha.114.005789",
      "authors": "www.ahajournals.org",
      "host": "www.ahajournals.org",
      "snippet": "Individuals randomized to dual antiplatelet therapy with clopidogrel and aspirin had an unanticipated increase in all-cause mortality compared with those",
      "score": 0.28500414
    },
    {
      "number": 24,
      "title": "European Stroke Organisation (ESO) guidelines on management of transient ischaemic attack - PMC",
      "detail": "pmc.ncbi.nlm.nih.gov",
      "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC8370080",
      "authors": "pmc.ncbi.nlm.nih.gov",
      "host": "pmc.ncbi.nlm.nih.gov",
      "snippet": "In clinical trials DAPT was started within 24 hours from symptoms onset in high-risk non-cardioembolic TIA (ABCD2 score of ≥4). The evidence base for maximal benefit-risk balance is with early and time limited (10 to 21 days) use of DAPT. An actively recruiting RCT (CHANCE-2) seeks to answer remaini",
      "score": 0.5803764
    }
  ],
  "publishedAt": "2026-08-21T02:36:16.015155+00:00",
  "updatedAt": "2026-08-21T02:36:16.015155+00:00",
  "readingMinutes": 6,
  "slug": "lacunar-stroke"
}