Location, size, and risk factors of incident covert brain infarcts in patients with acute non-cardioembolic ischemic stroke: PACIFIC-STROKE trial.

IF 4.5 3区医学 Q1 CLINICAL NEUROLOGY

European Stroke Journal Pub Date : 2025-06-13 DOI:10.1177/23969873251344485

Robert G Hart, Eric E Smith, Angela Wang, Hardi Mundl, Pablo Colorado, Raed A Joundi, Aristeidis H Katsanos, Mukul Sharma, Ashkan Shoamanesh

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引用次数: 0

Abstract

Introduction: Covert brain infarcts (CBIs) identified by imaging are more frequent than symptomatic ischemic strokes and are usually small and/or involve non-eloquent brain areas. The spectrum of incident CBIs in patients following acute ischemic stroke has not been well characterized.

Patients and methods: Exploratory observational cohort study of the size, location, multiplicity and risk factors of incident CBIs identified using serial MRIs in patients with acute non-cardioembolic ischemic stroke participating in the PACIFIC-STROKE trial.

Results: Incident CBIs were identified in 16% (220/1358) of participants during the mean 5.6-month interval between MRIs. Single incident CBIs occurred in 150 (68%) of incident CBI patients and multiple CBIs in 70 (32%); 42% (93/220) of incident CBI patients had a single, small, subcortical CBI. There was no clear relationship between the location of incident CBI and the location of index stroke. Significant independent features associated with incident CBI included diabetes (adjusted OR 1.52, 95%CI 1.09-2.12), current tobacco use (adjusted OR 1.50, 95%CI 1.07-2.09), prior stroke/TIA (adjusted OR 1.59, 95%CI 1.08-2.36), carotid artery atherosclerosis (adjusted OR 1.47, 95%CI 1.07-2.02), and diastolic blood pressure (adjusted OR 1.02 per 1 mmHg increase, 95%CI 1.01-1.04).

Discussion and conclusion: Incident CBIs in patients following acute non-cardioembolic stroke were frequent, usually small and subcortical, and associated with traditional stroke risk factors. Observations from PACIFIC-STROKE, particularly the absence of correlation between the location of incident CBI and the index infarct and the high frequency of incident small, subcortical CBIs, suggest that incident CBI pathogenesis is complex and heterogeneous in this population.

Trial registration: https://clinicaltrials.gov (NCT04304508).

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急性非心源性缺血性卒中患者隐蔽性脑梗死的位置、大小和危险因素：PACIFIC-STROKE试验

隐蔽性脑梗死（cbi）比有症状的缺血性中风更常见，通常是小的和/或涉及非流利的脑区。急性缺血性脑卒中患者发生脑卒中的频谱尚未得到很好的表征。患者和方法：对参与PACIFIC-STROKE试验的急性非心栓塞性缺血性卒中患者的连续mri识别的CBIs的大小、位置、多样性和危险因素进行探索性观察队列研究。结果：16%（220/1358）的参与者在平均5.6个月的mri间隔期间发现了突发脑梗死。150例（68%）CBI患者发生单次脑损伤，70例（32%）发生多次脑损伤；42%（93/220）的CBI患者为单一的、小的、皮质下的CBI。发生CBI的位置与指数卒中的位置之间没有明确的关系。与CBI事件相关的重要独立特征包括糖尿病（调整OR为1.52,95%CI 1.09-2.12）、当前吸烟（调整OR为1.50,95%CI 1.07-2.09）、既往卒中/TIA（调整OR为1.59,95%CI 1.08-2.36）、颈动脉粥样硬化（调整OR为1.47,95%CI 1.07-2.02）和舒张压（调整OR为1.02 / 1mmhg升高，95%CI 1.01-1.04）。讨论与结论：急性非心源性卒中患者的脑卒中发生率高，通常较小且位于皮质下，与传统卒中危险因素相关。来自PACIFIC-STROKE的观察，特别是CBI的发生地点与梗死指数之间缺乏相关性，以及小的皮质下CBI的高发生率，表明CBI的发病机制在该人群中是复杂和异质性的。试验注册：https://clinicaltrials.gov （NCT04304508）。

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

European Stroke Journal Multiple-

CiteScore

7.50

自引率

6.60%

发文量

102

期刊介绍： Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.