European stroke organisation (ESO) guideline on cerebral small vessel disease, part 2, lacunar ischaemic stroke
(2024) In European Stroke Journal- Abstract
A quarter of ischaemic strokes are lacunar subtype, typically neurologically mild, usually resulting from intrinsic cerebral small vessel pathology, with risk factor profiles and outcome rates differing from other stroke subtypes. This European Stroke Organisation (ESO) guideline provides evidence-based recommendations to assist with clinical decisions about management of lacunar ischaemic stroke to prevent adverse clinical outcomes. The guideline was developed according to ESO standard operating procedures and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. We addressed acute treatment (including progressive lacunar stroke) and secondary prevention in lacunar ischaemic stroke, and prioritised... (More)
A quarter of ischaemic strokes are lacunar subtype, typically neurologically mild, usually resulting from intrinsic cerebral small vessel pathology, with risk factor profiles and outcome rates differing from other stroke subtypes. This European Stroke Organisation (ESO) guideline provides evidence-based recommendations to assist with clinical decisions about management of lacunar ischaemic stroke to prevent adverse clinical outcomes. The guideline was developed according to ESO standard operating procedures and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. We addressed acute treatment (including progressive lacunar stroke) and secondary prevention in lacunar ischaemic stroke, and prioritised the interventions of thrombolysis, antiplatelet drugs, blood pressure lowering, lipid lowering, lifestyle, and other interventions and their potential effects on the clinical outcomes recurrent stroke, dependency, major adverse cardiovascular events, death, 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 with suspected acute lacunar ischaemic stroke receive intravenous alteplase, antiplatelet drugs and avoid blood pressure lowering according to current acute ischaemic stroke guidelines. For secondary prevention, we recommend single antiplatelet treatment long-term, blood pressure control, and lipid lowering according to current guidelines. We recommend smoking cessation, regular exercise, other healthy lifestyle modifications, and avoid obesity for general health benefits. We cannot make any recommendation concerning progressive stroke or other drugs. Large randomised controlled trials with clinically important endpoints, including cognitive endpoints, are a priority for lacunar ischaemic stroke.
(Less)
- author
- organization
- publishing date
- 2024
- type
- Contribution to journal
- publication status
- epub
- subject
- keywords
- alteplase, antihypertensive, antiplatelet, Guideline, lacunar stroke, lipid lowering, small vessel disease, stroke, systematic review, thrombolysis
- in
- European Stroke Journal
- publisher
- SAGE Publications
- external identifiers
-
- pmid:38380638
- scopus:85186588177
- ISSN
- 2396-9873
- DOI
- 10.1177/23969873231219416
- language
- English
- LU publication?
- yes
- id
- 9f1b51fd-32ac-4d79-938f-7fe8da9a8ebe
- date added to LUP
- 2024-03-20 15:54:47
- date last changed
- 2024-04-17 15:33:08
@article{9f1b51fd-32ac-4d79-938f-7fe8da9a8ebe,
abstract = {{<p>A quarter of ischaemic strokes are lacunar subtype, typically neurologically mild, usually resulting from intrinsic cerebral small vessel pathology, with risk factor profiles and outcome rates differing from other stroke subtypes. This European Stroke Organisation (ESO) guideline provides evidence-based recommendations to assist with clinical decisions about management of lacunar ischaemic stroke to prevent adverse clinical outcomes. The guideline was developed according to ESO standard operating procedures and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. We addressed acute treatment (including progressive lacunar stroke) and secondary prevention in lacunar ischaemic stroke, and prioritised the interventions of thrombolysis, antiplatelet drugs, blood pressure lowering, lipid lowering, lifestyle, and other interventions and their potential effects on the clinical outcomes recurrent stroke, dependency, major adverse cardiovascular events, death, 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 with suspected acute lacunar ischaemic stroke receive intravenous alteplase, antiplatelet drugs and avoid blood pressure lowering according to current acute ischaemic stroke guidelines. For secondary prevention, we recommend single antiplatelet treatment long-term, blood pressure control, and lipid lowering according to current guidelines. We recommend smoking cessation, regular exercise, other healthy lifestyle modifications, and avoid obesity for general health benefits. We cannot make any recommendation concerning progressive stroke or other drugs. Large randomised controlled trials with clinically important endpoints, including cognitive endpoints, are a priority for lacunar ischaemic stroke.</p>}},
author = {{Wardlaw, Joanna M. and Chabriat, Hugues and de Leeuw, Frank Erik and Debette, Stéphanie and Dichgans, Martin and Doubal, Fergus and Jokinen, Hanna and Katsanos, Aristeidis H. and Ornello, Raffaele and Pantoni, Leonardo and Pasi, Marco and Pavlovic, Aleksandra M. and Rudilosso, Salvatore and Schmidt, Reinhold and Staals, Julie and Taylor-Rowan, Martin and Hussain, Salman and Lindgren, Arne G.}},
issn = {{2396-9873}},
keywords = {{alteplase; antihypertensive; antiplatelet; Guideline; lacunar stroke; lipid lowering; small vessel disease; stroke; systematic review; thrombolysis}},
language = {{eng}},
publisher = {{SAGE Publications}},
series = {{European Stroke Journal}},
title = {{European stroke organisation (ESO) guideline on cerebral small vessel disease, part 2, lacunar ischaemic stroke}},
url = {{http://dx.doi.org/10.1177/23969873231219416}},
doi = {{10.1177/23969873231219416}},
year = {{2024}},
}