Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
Department of Neurology, Tokyo Medical University Hospital, Tokyo, Japan.
J Neurol. 2020 May;267(5):1482-1490. doi: 10.1007/s00415-020-09732-4. Epub 2020 Feb 3.
Cryptogenic stroke encompasses diverse emboligenic mechanisms and pathogeneses. Cerebral microbleeds (CMBs) occur differently among stroke subtypes. The association of CMBs with cryptogenic stroke is essentially unknown.
CHALLENGE ESUS/CS (Mechanisms of Embolic Stroke Clarified by Transesophageal Echocardiography for ESUS/CS) is a multicenter registry with comprehensive data including gradient-echo T2*-weighted magnetic resonance imaging of cryptogenic stroke patients who underwent transesophageal echocardiography. Patients' clinical characteristics were compared according to the presence and location of CMBs.
A total of 661 patients (68.7 ± 12.7 years; 445 males) were enrolled, and 209 (32%) had CMBs. Age (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.00-1.04, p = 0.020), male sex (OR 1.85, 95% CI 1.18-2.91, p = 0.007), hypertension (OR 1.71, 95% CI 1.03-2.86, p = 0.039), chronic kidney disease (OR 1.64, 95% CI 1.11-2.43, p = 0.013), deep and subcortical white matter hyperintensity (OR 1.82, 95% CI 1.16-2.85, p = 0.009), and periventricular hyperintensity (OR 2.18, 95% CI 1.37-3.46, p = 0.001) were independently associated with the presence of CMBs. Aortic complicated lesions (OR 1.78, 95% CI 1.12-2.84, p = 0.015) were associated with deep and diffuse CMBs, whereas prior anticoagulant therapy (OR 7.88, 95% CI, 1.83-33.9, p = 0.006) was related to lobar CMBs.
CMBs were common, and age, male sex, hypertension, chronic kidney disease, and cerebral white matter diseases were related to CMBs in cryptogenic stroke. Aortic complicated lesions were associated with deep and diffuse CMBs, while prior anticoagulant therapy was related to lobar CMBs.
隐源性卒中包括多种栓子形成机制和发病机制。脑微出血（CMBs）在不同类型的卒中中发生情况不同。CMBs 与隐源性卒中的关系尚不清楚。
CHALLENGE ESUS/CS（经食管超声心动图明确 ESUS/CS 的栓塞性卒中机制）是一项多中心登记研究，包含接受经食管超声心动图检查的隐源性卒中患者的全面数据，包括梯度回波 T2*-加权磁共振成像。根据 CMBs 的存在和位置比较患者的临床特征。
共纳入 661 例患者（68.7±12.7 岁；445 例男性），其中 209 例（32%）有 CMBs。年龄（比值比 [OR] 1.02，95%置信区间 [CI] 1.00-1.04，p=0.020）、男性（OR 1.85，95%CI 1.18-2.91，p=0.007）、高血压（OR 1.71，95%CI 1.03-2.86，p=0.039）、慢性肾脏病（OR 1.64，95%CI 1.11-2.43，p=0.013）、深部和皮质下脑白质高信号（OR 1.82，95%CI 1.16-2.85，p=0.009）和脑室周围高信号（OR 2.18，95%CI 1.37-3.46，p=0.001）与 CMBs 的存在独立相关。主动脉复杂病变（OR 1.78，95%CI 1.12-2.84，p=0.015）与深部弥漫性 CMBs 相关，而既往抗凝治疗（OR 7.88，95%CI 1.83-33.9，p=0.006）与脑叶 CMBs 相关。
CMBs 很常见，年龄、男性、高血压、慢性肾脏病和脑白质疾病与隐源性卒中的 CMBs 有关。主动脉复杂病变与深部弥漫性 CMBs 相关，而既往抗凝治疗与脑叶 CMBs 相关。
