A Combined Treatment for Acute Larger Lacunar-Type Infarction

Larger lacunar-type infarcts (LLIs), presumably caused by occlusion at the orifices or proximal portions of larger-caliber penetrating arteries by atheromatous plaque, are frequently associated with progressive motor deficits (PMD) and lead to poor functional outcome. This study was conducted to examine the efficacy of a combined treatment to prevent PMD or improve the functional outcome in patients with LLI. A total of 218 consecutive patients with LLI and motor lacunar syndrome were enrolled, including 138 patients with infarcts in the territory of the lenticulostriate artery and anterior choroidal artery (supratentrial group) and 80 patients with infarcts in the territory of the anterior pontine artery (pontine group). The prevalence of PMD and functional outcome represented by modified Rankin Scale (mRS) score at 1 month after ictus were compared between groups treated with a combined treatment approach consisting of cilostazol and edaravone (n = 100) and a conventional treatment approach (n = 118). The efficacy of the combined treatment provided in 2005-2009 was compared with conventional treatment provided in 2001-2005. There was no significant difference in the prevalence of PMD between the 2 treatment groups. The combined treatment group had significantly more favorable outcomes compared with the conventional treatment group in the total population (P = .0078, Wilcoxon Mann-Whitney test) and in the pontine group (P = .0042). Logistic regression analysis showed that an initial National Institutes of Health Stroke Scale score <4, the absence of PMD, and the novel combined treatment approach were independently associated with favorable functional outcome. The novel combined treatment approach was safe and effective in improving functional outcome in acute LLI, but not effective in preventing PMD.