Prevalence of vessel wall abnormalities and the risk of recurrent vascular events in young patients with stroke.

Introduction: We examined the prevalence and the characteristics of vessel wall (VW) lesions in young stroke patients and their relation to recurrent vascular events. We hypothesize that having VW lesions is associated with an increased risk on recurrent vascular events.

Patients and methods: Single-center prospective study of participants aged 18-50 years, with a transient ischemic attack (TIA) or ischemic stroke, who underwent high-resolution 3T magnetic resonance imaging (HR-MRI) with VW imaging. We included 10 controls with symptoms diagnosed as stroke mimics. The HR-MRI scans were reviewed by two neuroradiologists blinded for clinical information. Follow-up was conducted via telephone interviews. Recurrent vascular events were defined as TIA, cerebral stroke, myocardial infarctions, revascularization procedures, or vascular death.

Results: We included 158 participants (median age: 41.5 years, IQR 33.0-46.4); 75 (47.5%) of whom were women. Of these, 44 (27.8%) participants had 81 VW lesions, primarily characterized by VW enhancement (74.1%). 86.4% of VW lesions were located in the corresponding ischemic territory, and 48.6% showed no MRA abnormalities. Almost half of the VW lesions were found in the rare causes subgroup, while 13.6% of the "cryptogenic" subgroup showed VW enhancement. VW lesions were not significantly associated with an increased risk of recurrent vascular events (HR 2.2, 95% CI: 0.7-6.6).

Conclusion: One in four young stroke patients have VW lesions, which were not related to an increased risk of recurrent vascular events. VW lesions were seen across all TOAST categories and were not specific to one stroke cause. Further research is needed to investigate the diagnostic and prognostic value of VW lesions in young stroke patients.