Determinants of the Recommendation of High-Resolution Vessel Wall Imaging for Young Patients With Posterior Circulation Ischemic Strokes.

Abstract

Objectives: High-resolution vessel wall imaging (HRVWI) has emerged as a crucial diagnostic method for improving the etiological classification of ischemic strokes, especially in younger patients. This study seeks to identify the factors that influence neurologists' decisions to recommend HRVWI for young individuals experiencing posterior circulation strokes.

Methods: In this retrospective study, we assessed the effect of HRVWI on the Trial of Org 10,172 in Acute Stroke Treatment (TOAST) classification among patients aged 45 years or younger with acute ischemic strokes in the posterior circulation. Logistic regression analysis was performed to determine the factors that predict HRVWI recommendations.

Results: Among 135 young stroke patients, 57 underwent HRVWI. The patients who received HRVWI were slightly younger (mean age 35.75 vs. 37.85 y; P=0.07). The use of HRVWI significantly changed the TOAST classification, increasing the identification of strokes attributed to other determined causes (ODC) from 28.2% to 50.9% and decreasing strokes of undetermined causes (UDC) from 18.0% to 7.0%. Notably, vertebrobasilar artery dissections (VBADs) were more frequently detected in the HRVWI group (82.8%) compared with the non-HRVWI group (21.1%). Multivariate logistic regression identified younger age, vertebrobasilar artery tortuosity, and stenosis or occlusion as significant predictors for HRVWI scans (age: P=0.044; tortuosity: P=0.006; stenosis or occlusion: P=0.021; respectively).

Conclusions: HRVWI may be considered for young stroke patients with abnormal arterial structures in the posterior circulation, as it significantly enhances the etiological classification of ischemic strokes.