Lacunar strokes are most frequently due to poorly- controlled hypertension.
Perforating vessels may occlude due to lipohyalinosis, micro-atheroma or fibrin. These first 2 mechanisms are pathological and likely due to chronic hypertension resulting in small vessel disease. (1)
Lacunar strokes are rarely due to emboli from a proximal source e.g. extracranial atherosclerosis or cardiac emboli.
Reference
Annotations allow you to add information to this page that would be handy to have on hand during a consultation. E.g. a website or number. This information will always show when you visit this page.