From the Research
Lenticulostriate vasculopathy (LSV) is associated with an increased risk of stroke, particularly in the basal ganglia and internal capsule regions, and management should prioritize blood pressure control and antiplatelet therapy to reduce this risk. When managing patients with LSV, close monitoring for stroke risk factors is essential. Some key points to consider in management include:
- Blood pressure control is critical, with a target of <130/80 mmHg using medications like ACE inhibitors (e.g., lisinopril 10-40 mg daily) or ARBs (e.g., losartan 50-100 mg daily) 1.
- Antiplatelet therapy with aspirin (75-100 mg daily) may be considered for primary prevention in high-risk patients, and in some cases, dual antiplatelet therapy with aspirin and clopidogrel may be beneficial for secondary stroke prevention, particularly in the first 30 days after a stroke event 2, 3.
- Regular neurological assessments and imaging follow-up with MRI every 6-12 months are recommended to monitor disease progression. LSV increases stroke risk because the affected vessels have reduced elasticity and narrowed lumens, compromising blood flow to vulnerable brain regions, as noted in studies on lenticulostriate infarction 4. The condition may be congenital or acquired, with risk factors including hypertension, diabetes, and inflammatory conditions, and early identification and aggressive management of modifiable risk factors are crucial to reducing stroke occurrence in patients with LSV 5. In terms of specific antiplatelet regimens, the choice of therapy should be individualized based on the stroke characteristics, time from symptom onset, and patient-specific predisposition to develop hemorrhagic complications, with consideration of the benefits and risks of different antiplatelet agents, including aspirin, clopidogrel, and ticagrelor 2.