Department of Neurology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.
Department of Neurology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.
J Stroke Cerebrovasc Dis. 2020 Jan;29(1):104489. doi: 10.1016/j.jstrokecerebrovasdis.2019.104489. Epub 2019 Nov 6.
Impairment of endothelial function is associated with atherosclerosis and atrial fibrillation, and could underlie several types of ischemic stroke. Embolic stroke of undetermined source (ESUS) recently attracted much attention as the major cause of cryptogenic stroke. This study aimed to clarify the endothelial function of patients with ESUS.
Between 2015 September and July 2017 July, we used flow-mediated vasodilation (FMD) test to evaluate vascular endothelial function in 182 patients with any vascular risk factors or a history of cerebrovascular events. The subject group was classified into the No Stroke group and 5 stroke subtype groups, large artery atherosclerosis (LAA), cardiogenic embolism (CE), small vessel disease (SVD), ESUS, and others (Other). Endothelial function was expressed as percentage increase in brachial vessel diameter (%FMD) after the interruption of blood flow with mechanical compression for 5 minutes. Mean FMD in the No stroke, LAA, CE, SVD, ESUS and Other groups were 7.03 ± 2.14%, 5.02 ± 2.75%, 4.97 ± 1.62%, 5.19 ± 2.67%, 3.55 ± 1.42%, and 6.55 ± 3.50%, respectively. After the adjustment for confounding factors, FMD was significantly lower in the ESUS group than in the No stroke, SVD, and Other groups. FMD tended to be lower in the ESUS group than in the LAA and CE groups, but the difference was not significant.
Endothelial function was impaired in patients with ESUS and may underlie its pathophysiology.
内皮功能障碍与动脉粥样硬化和心房颤动有关，并可能是多种缺血性卒中的基础。不明来源栓塞性卒中（ESUS）最近作为隐源性卒中的主要病因引起了广泛关注。本研究旨在阐明 ESUS 患者的内皮功能。
在 2015 年 9 月至 2017 年 7 月期间，我们使用血流介导的血管扩张（FMD）试验评估了 182 名存在任何血管危险因素或脑血管事件史的患者的血管内皮功能。将研究对象分为无卒中组和 5 种卒中亚型组，包括大动脉粥样硬化（LAA）、心源性栓塞（CE）、小血管疾病（SVD）、ESUS 和其他（Other）。内皮功能通过血流中断 5 分钟后肱动脉直径的百分比增加（%FMD）表示。无卒中、LAA、CE、SVD、ESUS 和其他组的平均 FMD 分别为 7.03±2.14%、5.02±2.75%、4.97±1.62%、5.19±2.67%、3.55±1.42%和 6.55±3.50%。调整混杂因素后，ESUS 组的 FMD 明显低于无卒中组、SVD 组和其他组。ESUS 组的 FMD 较 LAA 组和 CE 组有降低趋势，但差异无统计学意义。
ESUS 患者的内皮功能受损，可能是其病理生理学的基础。
