Das Alvin S, Regenhardt Robert W, Feske Steven K, Gurol Mahmut Edip
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
J Stroke Cerebrovasc Dis. 2019 Aug;28(8):2055-2078. doi: 10.1016/j.jstrokecerebrovasdis.2019.05.004. Epub 2019 May 28.
Lacunar strokes are appropriately named for their ability to cavitate and form ponds or "little lakes" (Latin: lacune -ae meaning pond or pit is a diminutive form of lacus meaning lake). They account for a substantial proportion of both symptomatic and asymptomatic ischemic strokes. In recent years, there have been several advances in the management of large vessel occlusions. New therapies such as non-vitamin K antagonist oral anticoagulants and left atrial appendage closure have recently been developed to improve stroke prevention in atrial fibrillation; however, the treatment of small vessel disease-related strokes lags frustratingly behind. Since Fisher characterized the lacunar syndromes and associated infarcts in the late 1960s, there have been no therapies specifically targeting lacunar stroke. Unfortunately, many therapeutic agents used for the treatment of ischemic stroke in general offer only a modest benefit in reducing recurrent stroke while adding to the risk of intracerebral hemorrhage and systemic bleeding. Escalation of antithrombotic treatments beyond standard single antiplatelet agents has not been effective in long-term lacunar stroke prevention efforts, unequivocally increasing intracerebral hemorrhage risk without providing a significant benefit. In this review, we critically review the available treatments for lacunar stroke based on evidence from clinical trials. For several of the major drugs, we summarize the adverse effects in the context of this unique patient population. We also discuss the role of neuroprotective therapies and neural repair strategies as they may relate to recovery from lacunar stroke.
腔隙性卒中因其能够形成空洞并形成小池或“小湖”（拉丁语：lacune -ae，意为池塘或坑，是lacus意为湖的小词形式）而得名。它们在有症状和无症状缺血性卒中中都占相当大的比例。近年来，大血管闭塞的治疗取得了一些进展。诸如非维生素K拮抗剂口服抗凝剂和左心耳封堵等新疗法最近已被开发出来，以改善心房颤动的卒中预防；然而，与小血管疾病相关的卒中治疗却令人沮丧地滞后。自20世纪60年代末费希尔描述了腔隙综合征及相关梗死以来，一直没有专门针对腔隙性卒中的治疗方法。不幸的是，一般用于治疗缺血性卒中的许多治疗药物在降低复发性卒中方面仅提供适度益处，同时增加了脑出血和全身出血的风险。在长期预防腔隙性卒中的努力中，超出标准单一抗血小板药物的抗栓治疗升级并未有效，明确增加了脑出血风险且未带来显著益处。在本综述中，我们基于临床试验证据对现有的腔隙性卒中治疗方法进行了批判性回顾。对于几种主要药物，我们在这一独特患者群体的背景下总结了其不良反应。我们还讨论了神经保护疗法和神经修复策略在腔隙性卒中恢复方面可能发挥的作用。
