The Severity of White Matter Lesions Possibly Influences Stroke Recurrence in Patients with Histories of Lacunar Infarctions.

Background To investigate the recurrent stroke types associated with white matter lesions (WMLs), we prospectively observed recurrences in patients with histories of lacunar infarctions (LIs). Methods We prospectively analyzed the types of stroke recurrences in 305 patients (138 women, 70.2 ± 11.7 years old) consecutively admitted to our hospital with LIs from April 2004 to December 2011. WMLs were graded using Fazekas' grades (Gr). Recurrence-free rate curves were generated by the Kaplan–Meier method using the log-rank test. Results The follow-up period was 50.7 ± 32.8 (.25-114) months. During this period, 62 strokes recurred. The incidences of strokes (all types), LIs, and deep intracerebral hemorrhages (ICHs) presenting as recurrences in 112 patients with Gr 2-3 were 6.2, 2.0, and 1.5 %/year, respectively, values that were significantly greater than those seen in 79 patients with Gr 0 (2.1 [ P  = .0001], .6 [ P  = .014], and .5 %/year [ P  = .016], respectively), and in 114 patients with Gr 1 (2.8 [ P  = .003], .9 [ P  = .009], and .6 %/year [ P  = .043], respectively). There was no significant difference among Gr 0, 1, and 2-3 in incidences of recurrences presenting as lobar ICHs, atherothrombotic infarctions, or cardioembolic infarctions. Multivariate analyses demonstrated that Gr 2-3 significantly and independently elevated the rate of deep ICHs or LIs presenting as recurrences after adjustment for risk factors. Conclusions The presence of high-grade WMLs elevated the rate of stroke recurrences presenting as LIs and deep ICHs, but not other types.