Optimal Treatment for Cerebral Lacunar Infarction
Sep 06, 2022
Source: Cainiu Health
Dr. Yang Jun
Introduction
Lacunar cerebral infarction generally refers to lacunar infarction in clinical practice—a type of ischemic stroke caused by small, deep cerebral infarcts. Treatment must be individualized according to the patient’s specific symptoms and disease severity, employing appropriate therapeutic strategies—including symptomatic treatment, pharmacotherapy, and, when indicated, surgical intervention. Pharmacotherapy primarily includes thrombolytic agents, antiplatelet agents, and anticoagulants.
Lacunar infarction generally refers to lacunar cerebral infarction in clinical practice, a type of ischemic stroke caused by small areas of ischemic microinfarction. Treatment should be individualized based on the patient's specific condition, including symptomatic management, medication, and surgical intervention when appropriate. There is no single "best" treatment method.
1. Symptomatic Treatment
For patients unable to breathe independently, maintaining airway patency is essential; airway support and oxygen supplementation should be provided when necessary. For hypertensive patients, gradual blood pressure reduction is recommended with close monitoring. In cases of hypotension, appropriate expansion of blood volume may be required. When blood glucose exceeds 11.1 mmol/L, prompt insulin therapy should be initiated to control hyperglycemia. For patients with swallowing difficulties, nutritional support can be established via nasogastric tube or gastrostomy feeding.
2. Pharmacological Treatment
(1) Thrombolytic agents: A key treatment for lacunar cerebral infarction. Commonly used drugs include recombinant tissue plasminogen activator (rt-PA) and urokinase, which effectively salvage the ischemic penumbra—brain tissue surrounding the infarct that is at risk but still potentially viable—thereby preventing progression to irreversible necrosis.
(2) Antiplatelet agents: Commonly prescribed medications include aspirin and clopidogrel, which help prevent platelet aggregation and subsequent thrombus formation.
(3) Anticoagulants: Commonly used drugs include heparin and warfarin. However, anticoagulation is not routinely recommended immediately after lacunar infarction, and its use is contraindicated within 24 hours following thrombolytic therapy.
3. Surgical Treatment
Lacunar cerebral infarction typically does not require surgical intervention. However, if the lesion affects vital centers in the brainstem or is complicated by acute massive hemorrhage, surgical treatment may be considered. This could involve resection of damaged brain tissue or vascular reconstruction using stents to restore cerebral blood flow.
