Evidence mapPaperPMID 38380638Full record

GuidelineEuropean stroke journal2024

European stroke organisation (ESO) guideline on cerebral small vessel disease, part 2, lacunar ischaemic stroke.

Joanna M Wardlaw, Hugues Chabriat, Frank-Erik de Leeuw, Stéphanie Debette, Martin Dichgans, Fergus Doubal, Hanna Jokinen, Aristeidis H Katsanos, Raffaele Ornello, Leonardo Pantoni and 8 more

Open access · hybridAbstract readSystematic ReviewPractice Guideline
In one paragraph

Guideline in European stroke journal, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
31citing papers in PubMed, 4 pooled it
19.3field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

31 citing papers in PubMed, 4 syntheses or guidelines pooled it, 50 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Early neurological deterioration in acute lacunar ischemic stroke: Systematic review of incidence, mechanisms, and prospects for treatment.International journal of stroke : official journal of the International Stroke Society · 2025
    Pooled it
  4. Pooled it
  5. Trial
  6. Optimal markers of treatment response to vasodilatory drugs in small vessel disease: An OxHARP trial analysis.International journal of stroke : official journal of the International Stroke Society · 2026
    Trial
  7. Trial
  8. Trial
  9. Trial
  10. Observational
  11. Article
  12. Systolic blood pressure and future stroke risk by asymptomatic brain lesions in a community MRI cohort: a retrospective study.Hypertension research : official journal of the Japanese Society of Hypertension · 2026
    Article
  13. Review
  14. Article
  15. Vascular cognitive impairment and dementia: Prevention, treatments, mechanisms and management options for the future.Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology · 2026
    Review
  16. Article
  17. Review
  18. Observational
  19. Article
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors at 18 institutions in 13 countries.

Joanna M WardlawCentre for Clinical Brain Sciences, UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK.ORCID 0000-0002-9812-6642
Hugues ChabriatCNVT and Department of Neurology, Hopital Lariboisière, Paris, France.ORCID 0000-0001-8436-6074
Frank-Erik de LeeuwDepartment of Neurology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
Stéphanie DebetteBordeaux Population Health Research Center; University of Bordeaux - Inserm U1219; Bordeaux; Department of Neurology, Institute for Neurodegenerative Diseases, Bordeaux University Hospital, Bordeaux, France.ORCID 0000-0001-8675-7968
Martin DichgansInstitute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Medical Center, Munich; Munich Cluster for Systems Neurology (SyNergy), Munich; German Center for Neurodegenerative Diseases (DZNE, Munich), Munich; German Centre for Cardiovascular Research (DZHK, Munich), Munich, Germany.ORCID 0000-0002-0654-387X
Fergus DoubalCentre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, Edinburgh, UK.ORCID 0000-0002-2769-3148
Hanna JokinenNeurocenter, Helsinki University Hospital and University of Helsinki, HUS, Helsinki, Finland.ORCID 0000-0001-7889-1120
Aristeidis H KatsanosNeurology, McMaster University & Population Health Research Institute, Hamilton, ON, Canada.ORCID 0000-0002-6359-0023
Raffaele OrnelloNeurology/Department of Biotechnological ad Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.ORCID 0000-0001-9501-4031
Leonardo PantoniNeurology and Stroke Unit, Luigi Sacco Hospital, Milan, Italy.ORCID 0000-0001-7357-8530
Marco PasiDepartment of Neurology, University of Tours, Tours, France.ORCID 0000-0001-9976-2459
Aleksandra M PavlovicUniversity of Belgrade, Faculty of Special Education and Rehabilitation, Belgrade, Serbia.ORCID 0000-0002-5987-9828
Salvatore RudilossoComprehensive Stroke Center, Department of Neurology, Hospital Clínic of Barcelona, Barcelona, Spain.ORCID 0000-0002-8775-6884
Reinhold SchmidtDepartment of Neurology, Medical University Graz, Graz, Austria.
Julie StaalsDepartment of Neurology and CARIM School for cardiovascular diseases, MUMC+, Maastricht, The Netherlands.ORCID 0000-0002-9502-6937
Martin Taylor-RowanSchool of Health and Wellbeing; General Practice and Primary Care, Clarice Pears Building, University of Glasgow, Glasgow, UK.ORCID 0000-0002-3027-5369
Salman HussainEuropean Stroke Organisation, Basel, Switzerland.ORCID 0000-0002-1691-8428
Arne G LindgrenDepartment of Clinical Sciences Lund, Neurology, Lund University; Department of Neurology, Skåne University Hospital, Lund, Skånes Universitetssjukhus, Lund, Sweden.ORCID 0000-0003-1942-7330
European CanCer Organisation · BEGerman Center for Neurodegenerative Diseases · DEHôpital Lariboisière · FRHospital Clínic de Barcelona · ESLuigi Sacco Hospital · ITLund University · SEMaastricht University Medical Centre · NLMedical University of Graz · ATPopulation Health Research Institute · CARadboud University Nijmegen · NLUK Dementia Research Institute · GBUniversité de Bordeaux · FRUniversité de Tours · FRUniversity of Belgrade · RSUniversity of Edinburgh · GBUniversity of Glasgow · GBUniversity of Helsinki · FIUniversity of L'Aquila · IT

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

A quarter of ischaemic strokes are lacunar subtype, typically neurologically mild, usually resulting from intrinsic cerebral small vessel pathology, with risk factor profiles and outcome rates differing from other stroke subtypes. This European Stroke Organisation (ESO) guideline provides evidence-based recommendations to assist with clinical decisions about management of lacunar ischaemic stroke to prevent adverse clinical outcomes. The guideline was developed according to ESO standard operating procedures and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. We addressed acute treatment (including progressive lacunar stroke) and secondary prevention in lacunar ischaemic stroke, and prioritised the interventions of thrombolysis, antiplatelet drugs, blood pressure lowering, lipid lowering, lifestyle, and other interventions and their potential effects on the clinical outcomes recurrent stroke, dependency, major adverse cardiovascular events, death, cognitive decline, mobility, gait, or mood disorders. We systematically reviewed the literature, assessed the evidence and where feasible formulated evidence-based recommendations, and expert concensus statements. We found little direct evidence, mostly of low quality. We recommend that patients with suspected acute lacunar ischaemic stroke receive intravenous alteplase, antiplatelet drugs and avoid blood pressure lowering according to current acute ischaemic stroke guidelines. For secondary prevention, we recommend single antiplatelet treatment long-term, blood pressure control, and lipid lowering according to current guidelines. We recommend smoking cessation, regular exercise, other healthy lifestyle modifications, and avoid obesity for general health benefits. We cannot make any recommendation concerning progressive stroke or other drugs. Large randomised controlled trials with clinically important endpoints, including cognitive endpoints, are a priority for lacunar ischaemic stroke.

Indexed as

Brain IschemiaCerebral Small Vessel DiseasesStrokeStroke, LacunarHumansLipidsPlatelet Aggregation InhibitorsLipidsPlatelet Aggregation InhibitorsalteplaseantihypertensiveantiplateletGuidelinelacunar strokelipid loweringsmall vessel diseasestrokesystematic reviewthrombolysis

Identifiers

PMID38380638
PMCPMC10916806
OpenAlexW4392003913

What Socratic holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.