Lacunar strokes are small ischaemic strokes associated with disease of the brain’s small penetrating vessels. Recent research has added detail to how structural changes in these vessels may differ from the large-artery atherosclerosis involved in some other stroke mechanisms.
This does not mean that medicine has discovered a new origin for ischaemic stroke in general. Ischaemic stroke has multiple causes, including large-artery disease, cardiac embolism and cerebral small-vessel disease. The relevant research concerns a particular subtype.
It also does not establish that aspirin, statins or other secondary-prevention medicines should be stopped in people with lacunar stroke. Treatment decisions take account of the patient’s overall vascular risk and the possibility of future events with different mechanisms.
The scientific importance lies in identifying better targets for cerebral small-vessel disease and developing trials that test treatments specifically against those mechanisms.
Anyone who has had a stroke or takes antiplatelet, blood-pressure or lipid-lowering treatment should not change medication on the basis of emerging research without speaking to the treating clinical team.
