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However, their clinical relevance remains unclear. We investigated the clinicoradiological correlates of \u2018caps\/tracks\u2019, and their impact on long\u2010term outcomes following RSSI.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We identified participants with lacunar stroke and MRI\u2010confirmed RSSI from 3 prospective studies. At baseline, we collected risk factors, RSSI characteristics, small vessel disease (SVD) features, and microstructural integrity on diffusion imaging. Over 1\u2010year, we repeated MRI and recorded \u2018caps\/tracks\u2019 blinded to other data. We evaluated predictors of \u2018caps\/tracks\u2019, and their association with 1\u2010year functional (modified Rankin Scale score \u22652), mobility (Timed Up\u2010and\u2010Go), cognitive outcomes (Montreal Cognitive Assessment [MoCA] score\u2009&lt;26), and recurrent cerebrovascular events (stroke\/transient ischemic attack\/incident infarct) using multivariable regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 185 participants, 93 (50.3%) developed \u2018caps\/tracks\u2019 first detected at median 198\u2009days after stroke. \u2018Caps\/tracks\u2019 were independently predicted by baseline factors: larger RSSI, RSSI located in white matter, higher SVD score, and higher mean diffusivity in normal\u2010appearing white matter (odds ratio [OR] [95% confidence interval {CI}], 1.15 [1.07\u20131.25], 6.01 [2.80\u201313.57], 1.77 [1.31\u20132.44], 1.42 [1.01\u20132.03]). At 1\u2009year, \u2018cap\/track\u2019 formation was associated with worse functional outcome (OR: 3.17, 95% CI: 1.28\u20138.22), slower gait speed (\u03b2: 0.13, 95% CI: 0.01\u20130.25), and recurrent cerebrovascular events (hazard ratio [HR]: 2.05, 95% CI: 1.05\u20134.02), but not with cognitive impairment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>\u2018Caps\/tracks\u2019 after RSSI are associated with worse clinical outcomes, and may reflect vulnerability to progressive SVD\u2010related injury. Reducing \u2018caps\/tracks\u2019 may offer early efficacy markers in trials aiming to improve outcome after lacunar stroke. 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