Intracranial Nonstenosing Atherosclerotic Plaques Assessed With Vessel Wall MRI in Patients With Embolic Stroke of Undetermined Source.

IF 8.5 1区 医学 Q1 CLINICAL NEUROLOGY
Neurology Pub Date : 2025-07-22 Epub Date: 2025-06-26 DOI:10.1212/WNL.0000000000213833
Federico Mazzacane, Beatrice Del Bello, Elisa Rognone, Carlo Asteggiano, Federica Ferrari, Alessandra Persico, Alfredo Costa, Roberto De Icco, Andrea Morotti, Anna Pichiecchio, Anna Cavallini
{"title":"Intracranial Nonstenosing Atherosclerotic Plaques Assessed With Vessel Wall MRI in Patients With Embolic Stroke of Undetermined Source.","authors":"Federico Mazzacane, Beatrice Del Bello, Elisa Rognone, Carlo Asteggiano, Federica Ferrari, Alessandra Persico, Alfredo Costa, Roberto De Icco, Andrea Morotti, Anna Pichiecchio, Anna Cavallini","doi":"10.1212/WNL.0000000000213833","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and objectives: </strong>Artery-to-artery embolization from vulnerable intracranial nonstenosing atherosclerotic plaques (vNSPs) has been proposed as a major contributor to embolic stroke of undetermined source (ESUS). Vessel wall MRI (VWMRI) offers the potential to identify culprit vNSPs, yet prospective studies in ESUS populations are lacking. This study aimed to assess the role of vNSPs in single-territory ESUS and to evaluate the utility of intracranial VWMRI in the diagnostic workup.</p><p><strong>Methods: </strong>Consecutive patients admitted to the Stroke Unit of the IRCCS Mondino Foundation (Pavia, Italy) with a confirmed ESUS diagnosis after a complete etiologic workup were prospectively enrolled in the study. Patients with multiterritorial ischemic lesions, complicated aortic arch atherosclerosis, or a probable patent foramen ovale-associated stroke were excluded. Intracranial VWMRI at 3-T was performed within 1 month of the index event. Atherosclerotic lesions were considered culprit if demonstrating postcontrast enhancement on T1-weighted images and a location consistent with ischemic lesions' distribution. Quantitative radiologic features of vNSPs were also analyzed.</p><p><strong>Results: </strong>A total of 80 patients (mean age 65.6 years, 34 [42.5%] women) were included. VWMRI identified a potentially culprit vNSP in 23 of 80 patients (28.8%, 95% CI 20-39.5). Patients with symptomatic vNSPs were older (72.7 vs 62.8 years, <i>p</i> = 0.002) and more frequently current (43.5 vs 35.1%) or former (30.4 vs 8.8%) smokers (<i>p</i> = 0.014). In a multivariable logistic regression model including major risk factors of intracranial atherosclerosis (age, smoking, hypertension, diabetes, and dyslipidemia), both age (adjusted odds ratio [aOR] 1.12, 95% CI 1.05-1.22, <i>p</i> = 0.002) and smoking status (active smokers: aOR 7.99, 95% CI 1.81-47.8, <i>p</i> = 0.011; former smokers: aOR 8.79, 95% CI 1.73-55.0, <i>p</i> = 0.012) were significantly associated with symptomatic vNSP.</p><p><strong>Discussion: </strong>Intracranial vNSPs may represent a significant underlying cause of single-territory ESUS, and VWMRI could provide an added value in the diagnostic workup of these patients. Older age and smoking exposure were found to be independently associated with the presence of culprit intracranial vNSPs. Further studies are needed to confirm our findings because of the relatively small and monocentric cohort.</p><p><strong>Classification of evidence: </strong>This study provides Class IV evidence that VWMRI improves the identification of culprit vNSPs in patients with ESUS.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 2","pages":"e213833"},"PeriodicalIF":8.5000,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1212/WNL.0000000000213833","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/6/26 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Background and objectives: Artery-to-artery embolization from vulnerable intracranial nonstenosing atherosclerotic plaques (vNSPs) has been proposed as a major contributor to embolic stroke of undetermined source (ESUS). Vessel wall MRI (VWMRI) offers the potential to identify culprit vNSPs, yet prospective studies in ESUS populations are lacking. This study aimed to assess the role of vNSPs in single-territory ESUS and to evaluate the utility of intracranial VWMRI in the diagnostic workup.

Methods: Consecutive patients admitted to the Stroke Unit of the IRCCS Mondino Foundation (Pavia, Italy) with a confirmed ESUS diagnosis after a complete etiologic workup were prospectively enrolled in the study. Patients with multiterritorial ischemic lesions, complicated aortic arch atherosclerosis, or a probable patent foramen ovale-associated stroke were excluded. Intracranial VWMRI at 3-T was performed within 1 month of the index event. Atherosclerotic lesions were considered culprit if demonstrating postcontrast enhancement on T1-weighted images and a location consistent with ischemic lesions' distribution. Quantitative radiologic features of vNSPs were also analyzed.

Results: A total of 80 patients (mean age 65.6 years, 34 [42.5%] women) were included. VWMRI identified a potentially culprit vNSP in 23 of 80 patients (28.8%, 95% CI 20-39.5). Patients with symptomatic vNSPs were older (72.7 vs 62.8 years, p = 0.002) and more frequently current (43.5 vs 35.1%) or former (30.4 vs 8.8%) smokers (p = 0.014). In a multivariable logistic regression model including major risk factors of intracranial atherosclerosis (age, smoking, hypertension, diabetes, and dyslipidemia), both age (adjusted odds ratio [aOR] 1.12, 95% CI 1.05-1.22, p = 0.002) and smoking status (active smokers: aOR 7.99, 95% CI 1.81-47.8, p = 0.011; former smokers: aOR 8.79, 95% CI 1.73-55.0, p = 0.012) were significantly associated with symptomatic vNSP.

Discussion: Intracranial vNSPs may represent a significant underlying cause of single-territory ESUS, and VWMRI could provide an added value in the diagnostic workup of these patients. Older age and smoking exposure were found to be independently associated with the presence of culprit intracranial vNSPs. Further studies are needed to confirm our findings because of the relatively small and monocentric cohort.

Classification of evidence: This study provides Class IV evidence that VWMRI improves the identification of culprit vNSPs in patients with ESUS.

来源不明的栓塞性脑卒中患者颅内非狭窄性动脉粥样硬化斑块的血管壁MRI评估。
背景和目的:易损性颅内非狭窄性动脉粥样硬化斑块(vNSPs)的动脉到动脉栓塞被认为是不明来源栓塞性卒中(ESUS)的主要原因。血管壁MRI (VWMRI)提供了识别罪魁祸首vNSPs的潜力,但缺乏ESUS人群的前瞻性研究。本研究旨在评估vNSPs在单区ESUS中的作用,并评估颅内VWMRI在诊断工作中的应用。方法:在完整的病因检查后,连续被IRCCS Mondino基金会(Pavia, Italy)卒中单元确诊为ESUS诊断的患者被前瞻性纳入研究。排除多区域缺血性病变、复杂主动脉弓动脉粥样硬化或可能的卵圆孔未闭相关卒中患者。3-T时颅内VWMRI在指数事件后1个月内进行。如果在t1加权图像上显示造影后增强且位置与缺血性病变分布一致,则认为动脉粥样硬化病变是罪魁祸首。定量分析了vNSPs的放射学特征。结果:共纳入80例患者,平均年龄65.6岁,女性34例(42.5%)。VWMRI在80例患者中发现了23例潜在的罪魁祸首vNSP (28.8%, 95% CI 20-39.5)。有症状的vNSPs患者年龄较大(72.7 vs 62.8岁,p = 0.002),并且更频繁地吸烟(43.5 vs 35.1%)或以前吸烟(30.4 vs 8.8%) (p = 0.014)。在包含颅内动脉粥样硬化主要危险因素(年龄、吸烟、高血压、糖尿病和血脂异常)的多变量logistic回归模型中,年龄(校正优势比[aOR] 1.12, 95% CI 1.05-1.22, p = 0.002)和吸烟状况(积极吸烟者:aOR 7.99, 95% CI 1.81-47.8, p = 0.011;前吸烟者:aOR 8.79, 95% CI 1.73-55.0, p = 0.012)与症状性vNSP显著相关。讨论:颅内vNSPs可能是单区ESUS的重要潜在原因,VWMRI可以为这些患者的诊断工作提供附加价值。年龄和吸烟暴露被发现与罪魁祸首颅内vNSPs的存在独立相关。由于研究对象相对较小且为单中心队列,因此需要进一步的研究来证实我们的发现。证据分类:本研究提供了IV类证据,证明VWMRI可以提高ESUS患者对罪魁祸首vNSPs的识别。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Neurology
Neurology 医学-临床神经学
CiteScore
12.20
自引率
4.00%
发文量
1973
审稿时长
2-3 weeks
期刊介绍: Neurology, the official journal of the American Academy of Neurology, aspires to be the premier peer-reviewed journal for clinical neurology research. Its mission is to publish exceptional peer-reviewed original research articles, editorials, and reviews to improve patient care, education, clinical research, and professionalism in neurology. As the leading clinical neurology journal worldwide, Neurology targets physicians specializing in nervous system diseases and conditions. It aims to advance the field by presenting new basic and clinical research that influences neurological practice. The journal is a leading source of cutting-edge, peer-reviewed information for the neurology community worldwide. Editorial content includes Research, Clinical/Scientific Notes, Views, Historical Neurology, NeuroImages, Humanities, Letters, and position papers from the American Academy of Neurology. The online version is considered the definitive version, encompassing all available content. Neurology is indexed in prestigious databases such as MEDLINE/PubMed, Embase, Scopus, Biological Abstracts®, PsycINFO®, Current Contents®, Web of Science®, CrossRef, and Google Scholar.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信