Differing associations of white matter lesions and lacunar infarction with retinal microvascular signs

G. Liew, M.L. Baker, T.Y. Wong, P.J. Hand, J.J. Wang, P. Mitchell, D.A. De Silva, M.-C. Wong, E. Rochtchina, R.I. Lindley, J.M. Wardlaw, Graeme J. Hankey

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    Background: White matter lesions (WML) and lacunar infarcts (LI) are believed to have microvascular etiologies but the exact microvascular changes occurring in each is unclear. Aim: Using the retina as a proxy, we assessed retinal microvascular changes in WML and LI. Methods: We prospectively recruited 1211 acute stroke patients. Four subgroups were identified from neuroimaging: WML alone, LI alone, both WML and LI, neither WML nor LI. Masked retinal photographs identified retinopathy and retinal arteriolar wall signs and measured retinal vascular caliber. Results: Compared with 448 controls with neither WML nor LI, 384 patients with only WML were more likely to have retinopathy [odds ratio (OR) 1·5, 95% confidence interval (CI) 1·1 to 2·1] and enhanced arteriolar light reflex (OR 1·6, 95% CI 1·1 to 2·3); 200 patients with only LI were more likely to have arteriolar narrowing (OR 1·6, 95% CI 1·1 to 2·3) and enhanced arteriolar light reflex (OR 1·6, 95% CI 1·0 to 2·4); and 179 patients with both WML and LI were more likely to have arteriovenous nicking (OR 1·7, 95% CI 1·1 to 2·6), enhanced arteriolar light reflex (OR 2·0, 95% CI 1·3 to 3·2) and wider venules (OR 2·3, 95% CI 1·4 to 3·6). All analyses were adjusted for age, gender, study site and cardiovascular risk factors. Conclusion: Both WML and LI were associated with retinal microvascular signs, supporting a microvascular etiology. Differing patterns of association suggest different mechanisms may predominate, e.g. greater endothelial permeability in WML, and ischemia associated with arteriolar wall disease in LI. © 2012 World Stroke Organization.
    Original languageEnglish
    Pages (from-to)921-925
    JournalInternational Journal of Stroke
    Issue number1
    Publication statusPublished - 1 Oct 2014


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