What causes lacunar stroke? A 7T magnetic resonance imaging study

Lacunar stroke results from ischaemia in the territory of the small perforator arteries which supply the white matter and deep grey matter. It causes a quarter of all stroke and is the major pathology underlying vascular dementia. Despite its importance we have very few treatments for it, largely due to a poor understanding of the pathogenesis.

Key questions are what is the underlying arterial pathology, how does this vary between patients, and can we identify specific groups who may benefit form particular preventative therapies.

We will use 7T MRI, which for the first time allows visualisation of the perforator arteries in vivo, to determine the underlying arterial changes in a series of 100 consecutive patients with lacunar stroke.

We will both use angiographic imaging to identify abnormalities within the perforating arteries, as well as arterial well imaging to determine the contribution of atheromatous plaques in the large arteries from which the perforators arise. We will determine the types, and frequencies, of arterial pathologies in lacunar stroke.

We will also determine whether clinical and conventional MRI could be used to predict the underlying arterial pathology in clinical patients, therefore allowing us to personalise treatment approaches to the underlying pathology.