Is cerebral angiography redundant in undetermined cause of stroke in patients below 50 years when the stroke is lacunar?

Abstract 

Background: In the diagnostic work-up of young stroke patients angiography is still considered as mandatory to identify otherwise undetected causes of stroke. We hypothesized that stroke cause is more heterogeneous among patients with a territorial infarct, whereas in lacunar stroke it is generally small vessel disease. Therefore, angiography yields more often a specific stroke cause in territorial than in lacunar infarct patients. Methods: Angiograms of 39 lacunar and 41 territorial brain infarct patients, aged between 14 and 51 years, and who had unexplained stroke cause, were evaluated. Results: 1 of the 39 lacunar (3%), and 18 of the 41 territorial stroke patients (44%) had abnormal angiogram: odds ratio 0.03, 95% confidence interval: 0.01–0.017. The predictive value of lacunar stroke for a normal angiogram was 97%. Conclusion: When undetermined cause of stroke in young patients is lacunar, it is highly predictive for a normal angiogram. Our data may be of value in deciding on performing angiography in individual young stroke patients, depending on whether the stroke is territorial or lacunar.

Keywords:  Lacunar stroke, Territorial stroke, Cerebral angiography, Young stroke