Chronic ischemic lesions and presence of patent foramen ovale in young adults with embolic stroke of undetermined source: Results of the young ESUS patient registry.

IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY
International Journal of Stroke Pub Date : 2024-04-01 Epub Date: 2023-12-11 DOI:10.1177/17474930231217917
Thomas Raphael Meinel, Kate Tsiplova, Amanda Taylor, Elena Meseguer, Karl Georg Haeusler, Robert G Hart, Marcel Arnold, Kanjana S Perera
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引用次数: 0

Abstract

Background: Chronic ischemic lesions (CILs) are frequent findings in patients with acute ischemic stroke, but their phenotypes and relevance in young adults with embolic stroke of undetermined source (Y-ESUS) remains uncertain. We aimed to compare Y-ESUS patients with CIL to those without CIL and assessed the association of CIL and its phenotypes with the presence of patent foramen ovale (PFO).

Methods: This prospective longitudinal, multicenter cohort study enrolled consecutive patients 50 years and younger with ESUS from October 2017 to October 2019 in 41 stroke research centers in 13 countries. Local investigators adjudicated presence and phenotypes of CIL on routine brain imaging (either magnetic resonance imaging (MRI) or computed tomography (CT)).

Results: Overall, 535 patients were enrolled (mean age = 40.4 (standard deviation (SD) = 7.3) years, 238 (44%) female). CILs were present in 76/534 (14.2%) patients with a median count CIL count of 1.0 (interquartile range (IQR) = 1-2), 42/76 (55%) had at least one cortical phenotype and 38/76 (50%) at least one non-cortical phenotype. Y-ESUS with CIL were less often female (32% vs 47% in non-CIL Y-ESUS), were older (mean 43 vs 40 years), had more often hypertension (42% vs 19%), diabetes (17% vs 7%), and hyperlipidemia (34% vs 18%). CIL Y-ESUS were independently associated with lower stroke recurrence (relative risk (RR) = 0.17 (0.05-0.61)). In Y-ESUS with PFO, CILs were less frequent in probable pathogenic PFO than with probable non-pathogenic PFO (6.1% vs 30% p< 0.001).

Conclusion: One in seven Y-ESUS patients has additional CIL. CILs were associated with several vascular risk factors, lower probability of a pathogenic PFO, and lower stroke recurrence.

来源不明的年轻成人栓塞性中风的慢性缺血性病变和卵圆孔未闭的存在——年轻ESUS患者登记结果
背景:慢性缺血性病变(CIL)是急性缺血性卒中患者的常见发现,但其表型及其与不明来源栓塞性卒中(Y-ESUS)的相关性仍不确定。我们的目的是比较有CIL和没有CIL的Y-ESUS患者,并评估CIL及其表型与卵圆孔未闭(PFO)存在的关系。方法:这项前瞻性纵向多中心队列研究于2017年10月至2019年10月在13个国家的41个卒中研究中心招募了50岁及以下ESUS患者。当地研究人员通过常规脑成像(MRI或CT)判定CIL的存在和表型。结果:共纳入535例患者,平均年龄40.4岁(SD 7.3),女性238例(44%)。CIL中位计数为1.0 (IQR: 1 ~ 2)的患者中有76/534(14.2%)存在CIL, 42/76(55%)至少有一种皮质表型,38/76(50%)至少有一种非皮质表型。Y-ESUS合并CIL的女性较少(32%对47%,非CIL Y-ESUS),年龄较大(平均43岁对40岁),高血压(42%对19%),糖尿病(17%对7%)和高脂血症(34%对18%)。CIL Y-ESUS与较低卒中复发率独立相关(RR 0.17(0.05-0.61))。在Y-ESUS合并PFO患者中,可能致病性PFO患者的CIL发生率低于可能非致病性PFO患者(6.1% vs 30%)。CIL与几种血管危险因素、较低的致病性PFO概率和较低的卒中复发率相关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
International Journal of Stroke
International Journal of Stroke 医学-外周血管病
CiteScore
13.90
自引率
6.00%
发文量
132
审稿时长
6-12 weeks
期刊介绍: The International Journal of Stroke is a welcome addition to the international stroke journal landscape in that it concentrates on the clinical aspects of stroke with basic science contributions in areas of clinical interest. Reviews of current topics are broadly based to encompass not only recent advances of global interest but also those which may be more important in certain regions and the journal regularly features items of news interest from all parts of the world. To facilitate the international nature of the journal, our Associate Editors from Europe, Asia, North America and South America coordinate segments of the journal.
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