OBJECTIVES: Pathological and clinical data suggest that patients presenting with ischaemic lacunar syndromes may be a heterogenous group. Those with isolated lacunar infarction are thought to have localised atherosclerosis whereas in those with coexisting leukoaraiois a distinct diffuse small vessel vasculopathy may be the predominant underlying pathology. The ACE insertion/deletion (I/D) polymorphism is an important candidate gene in ischaemic cerebrovascular disease but, where lacunar stroke specifically has been examined, there have been discrepant reports concerning a possible association. It was hypothesised that the influence of the ACE gene may be different among the two subgroups of ischaemic lacunar stroke reflecting the heterogeneity of the small vessel disease phenotype. METHODS: Eighty four consecutive patients presenting with classic lacunar syndromes were studied. All had acute cranial CT to exclude primary intracerebral haemorrhage and these were subsequently assessed for the presence and extent of leukoaraiosis. All patients were genotyped for the ACE insertion/deletion polymorphism. RESULTS: There was a significant difference in the distribution of ACE genotype with the DD genotype occurring more often in patients with leukoaraiosis and the II and ID genotypes occurring more often among those in whom this was absent (chi(2)=9.06, p=0.01). In a logistic regression model the ACE DD genotype remained as an independent predictor for the presence of leukoaraiosis (p=0.02) in patients presenting with classic lacunar syndromes. CONCLUSION: This study supports the hypothesis that there may be different types of small vessel disease in patients with classic lacunar syndromes and that the influence of the ACE DD genotype may be relevant in mediating the diffuse form of vessel injury.
OBJECTIVES: Pathological and clinical data suggest that patients presenting with ischaemic lacunar syndromes may be a heterogenous group. Those with isolated lacunar infarction are thought to have localised atherosclerosis whereas in those with coexisting leukoaraiois a distinct diffuse small vessel vasculopathy may be the predominant underlying pathology. The ACE insertion/deletion (I/D) polymorphism is an important candidate gene in ischaemic cerebrovascular disease but, where lacunar stroke specifically has been examined, there have been discrepant reports concerning a possible association. It was hypothesised that the influence of the ACE gene may be different among the two subgroups of ischaemic lacunar stroke reflecting the heterogeneity of the small vessel disease phenotype. METHODS: Eighty four consecutive patients presenting with classic lacunar syndromes were studied. All had acute cranial CT to exclude primary intracerebral haemorrhage and these were subsequently assessed for the presence and extent of leukoaraiosis. All patients were genotyped for the ACE insertion/deletion polymorphism. RESULTS: There was a significant difference in the distribution of ACE genotype with the DD genotype occurring more often in patients with leukoaraiosis and the II and ID genotypes occurring more often among those in whom this was absent (chi(2)=9.06, p=0.01). In a logistic regression model the ACE DD genotype remained as an independent predictor for the presence of leukoaraiosis (p=0.02) in patients presenting with classic lacunar syndromes. CONCLUSION: This study supports the hypothesis that there may be different types of small vessel disease in patients with classic lacunar syndromes and that the influence of the ACE DD genotype may be relevant in mediating the diffuse form of vessel injury.
Authors: David Brenner; Julien Labreuche; Fernando Pico; Philip Scheltens; Odette Poirier; François Cambien; Pierre Amarenco Journal: J Neurol Date: 2008-05-02 Impact factor: 4.849
Authors: A Vilar-Bergua; I Riba-Llena; C Nafría; A Bustamante; V Llombart; P Delgado; J Montaner Journal: J Cereb Blood Flow Metab Date: 2016-01 Impact factor: 6.200
Authors: Myriam Fornage; Thomas H Mosley; Clifford R Jack; Mariza de Andrade; Sharon L R Kardia; Eric Boerwinkle; Stephen T Turner Journal: Hum Genet Date: 2006-09-22 Impact factor: 4.132
Authors: Edith Hofer; Margherita Cavalieri; Joshua C Bis; Charles DeCarli; Myriam Fornage; Sigurdur Sigurdsson; Velandai Srikanth; Stella Trompet; Benjamin F J Verhaaren; Christiane Wolf; Qiong Yang; Hieab H H Adams; Philippe Amouyel; Alexa Beiser; Brendan M Buckley; Michele Callisaya; Ganesh Chauhan; Anton J M de Craen; Carole Dufouil; Cornelia M van Duijn; Ian Ford; Paul Freudenberger; Rebecca F Gottesman; Vilmundur Gudnason; Gerardo Heiss; Albert Hofman; Thomas Lumley; Oliver Martinez; Bernard Mazoyer; Chris Moran; Wiro J Niessen; Thanh Phan; Bruce M Psaty; Claudia L Satizabal; Naveed Sattar; Sabrina Schilling; Dean K Shibata; P Eline Slagboom; Albert Smith; David J Stott; Kent D Taylor; Russell Thomson; Anna M Töglhofer; Christophe Tzourio; Mark van Buchem; Jing Wang; Rudi G J Westendorp; B Gwen Windham; Meike W Vernooij; Alex Zijdenbos; Richard Beare; Stéphanie Debette; M Arfan Ikram; J Wouter Jukema; Lenore J Launer; W T Longstreth; Thomas H Mosley; Sudha Seshadri; Helena Schmidt; Reinhold Schmidt Journal: Stroke Date: 2015-10-08 Impact factor: 7.914