Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Cerebrovasc Dis. 2012;33(6):549-57. doi: 10.1159/000338018. Epub 2012 Jun 8.
Aortic arch atheroma (AAA) has been accepted as a possible embolic source in patients with ischemic stroke, especially cryptogenic stroke. However, despite its well-known role as a risk factor for stroke, research focused on the mechanism or characteristics of stroke caused by AAA is insufficient. In this study, we aimed to evaluate clinical and radiological characteristics including lesion pattern on DWI in acute stroke patients associated with vulnerable AAA detected by multidetector row computed tomography (MDCT).
From September 2008 through May 2011, patients who presented with acute ischemic stroke and underwent MDCT were found in a prospective stroke registry. Patients without evident stroke etiology were included and classified by presence of vulnerable AAA. Vulnerable AAA was defined as (i) at least 6 mm thick adjacent to the aortic wall; (ii) ulcerated plaque, or (iii) soft plaque. Soft plaque was defined as the presence of clearly visualized area of hypoattenuation (<80 Hounsfield units) suggestive of thrombus. The patients without vulnerable AAA were classified as no/simple AAA group. The characteristics of diffusion-weighted MRI (DWI) lesions were analyzed in terms of the number and size of the lesions, and the involved vascular territories.
A total of 63 cryptogenic stroke patients were included in this study. Vulnerable AAA was observed in 15 (23.8%) patients. The patients with vulnerable AAA were older than those with no/simple AAA (p = 0.026). DWI analysis revealed that the vulnerable AAA group had a greater chance of having multiple and small lesions in multiple vascular territories that were mainly located in cortical and border-zone regions than the no/simple AAA group. Multiple logistic regression analysis showed that age (odds ratio 1.17; 95% confidence interval 1.02-1.34) and multiple small lesions in multiple vascular territories (odds ratio 33.18; 95% confidence interval 4.26-258.45) were independently associated with vulnerable AAA.
Vulnerable AAA is independently associated with a DWI pattern characterized by multiple small scattered lesions in multiple vascular territories in conjunction with age. It may help determine stroke mechanism quickly and easily, and provide more information about the pathomechanism of vulnerable AAA-related stroke.
主动脉弓粥样硬化（AAA）已被认为是缺血性卒中患者，尤其是隐源性卒中患者的可能栓子来源。然而，尽管 AAA 作为卒中的危险因素已广为人知，但针对 AAA 引起的卒中的机制或特征的研究还不够充分。在这项研究中，我们旨在评估包括多排 CT（MDCT）检测到的易损性 AAA 患者的急性卒中患者的临床和影像学特征，包括 DWI 上的病变模式。
从 2008 年 9 月至 2011 年 5 月，在一个前瞻性卒中登记处发现了因急性缺血性卒中而行 MDCT 检查的患者。纳入了无明显卒中病因的患者，并根据易损性 AAA 的存在进行分类。易损性 AAA 定义为：（i）至少 6mm 厚的毗邻主动脉壁；（ii）溃疡斑块，或（iii）软斑块。软斑块定义为存在明显低衰减区（<80 亨氏单位），提示血栓形成。无易损性 AAA 的患者被归类为无/简单 AAA 组。根据病变数量和大小以及受累血管区域分析弥散加权 MRI（DWI）病变的特征。
共有 63 例隐源性卒中患者纳入本研究。15 例（23.8%）患者存在易损性 AAA。与无/简单 AAA 组相比，易损性 AAA 组患者年龄更大（p=0.026）。DWI 分析显示，易损性 AAA 组患者更有可能出现多发性小病变，病变位于多个血管区域，主要位于皮质和交界区。多因素 logistic 回归分析显示，年龄（比值比 1.17；95%置信区间 1.02-1.34）和多发性小病变位于多个血管区域（比值比 33.18；95%置信区间 4.26-258.45）是易损性 AAA 的独立相关因素。
易损性 AAA 与年龄相关，其特征是 DWI 上表现为多发性小散在病变位于多个血管区域。它可能有助于快速、轻松地确定卒中机制，并提供有关易损性 AAA 相关卒中的发病机制的更多信息。
