A new prospective study of mild stroke patients challenges the long-held assumption that large artery blockages are a major contributor to lacunar stroke. Researchers found that widening and elongation of arteries in the brain, known as dolichoectasia or 'baggy arteries,' was strongly associated with lacunar stroke and progression of cerebral small vessel disease.
Baggy Arteries and Stroke Risk
In a study of 229 patients with mild stroke, large artery stenosis was present in 20.5% of participants, while basilar artery dolichoectasia was seen in 15.7%. After adjusting for risk factors, large artery stenosis showed no link to small vessel disease markers or new infarcts. In contrast, basilar artery dolichoectasia was associated with a nearly fivefold increased odds of lacunar stroke.
The findings suggest that intrinsic microvascular pathology-not atherosclerotic narrowing-may be the primary driver. This may explain why antiplatelet drugs have limited effectiveness in preventing lacunar stroke. Emerging treatments, including trials of cilostazol and isosorbide mononitrate, are now targeting small vessel function directly.