Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany.
Department of Radiology, University Hospital, LMU Munich, Munich, Germany; Department of Radiology, Trauma Center Murnau, Murnau, Germany.
J Am Coll Cardiol. 2020 Nov 10;76(19):2212-2222. doi: 10.1016/j.jacc.2020.09.532.
The underlying etiology of ischemic stroke remains unknown in up to 30% of patients.
This study explored the causal role of complicated (American Heart Association-lesion type VI) nonstenosing carotid artery plaques (CAPs) in cryptogenic stroke (CS).
CAPIAS (Carotid Plaque Imaging in Acute Stroke) is an observational multicenter study that prospectively recruited patients aged older than 49 years with acute ischemic stroke that was restricted to the territory of a single carotid artery on brain magnetic resonance imaging (MRI) and unilateral or bilateral CAP (≥2 mm, NASCET [North American Symptomatic Carotid Endarterectomy Trial] <70%). CAP characteristics were determined qualitatively and quantitatively by high-resolution, contrast-enhanced carotid MRI at 3T using dedicated surface coils. The pre-specified study hypotheses were that that the prevalence of complicated CAP would be higher ipsilateral to the infarct than contralateral to the infarct in CS and higher in CS compared with patients with cardioembolic or small vessel stroke (CES/SVS) as a combined reference group. Patients with large artery stroke (LAS) and NASCET 50% to 69% stenosis served as an additional comparison group.
Among 234 recruited patients, 196 had either CS (n = 104), CES/SVS (n = 79), or LAS (n = 19) and complete carotid MRI data. The prevalence of complicated CAP in patients with CS was significantly higher ipsilateral (31%) to the infarct compared with contralateral to the infarct (12%; p = 0.0005). Moreover, the prevalence of ipsilateral complicated CAP was significantly higher in CS (31%) compared with CES/SVS (15%; p = 0.02) and lower in CS compared with LAS (68%; p = 0.003). Lipid-rich and/or necrotic cores in ipsilateral CAP were significantly larger in CS compared with CES/SVS (p < 0.05).
These findings substantiate the role of complicated nonstenosing CAP as an under-recognized cause of stroke. (Carotid Plaque Imaging in Acute Stroke [CAPIAS]; NCT01284933).
多达 30%的缺血性脑卒中患者的潜在病因仍不清楚。
本研究旨在探讨复杂（美国心脏协会病变类型 VI）非狭窄颈动脉斑块（CAP）在隐源性脑卒中（CS）中的因果作用。
CAPIAS（急性脑卒中颈动脉斑块成像）是一项前瞻性多中心研究，招募年龄大于 49 岁的急性缺血性脑卒中患者，这些患者的脑磁共振成像（MRI）显示单侧或双侧 CAP（≥2mm，NASCET[北美症状性颈动脉内膜切除术试验]＜70%）局限于单一颈动脉区域。采用专用表面线圈，在 3T 高分辨率、对比增强颈动脉 MRI 上定性和定量评估 CAP 特征。本研究的预设假设是，在 CS 中，与对侧相比，同侧梗死侧的复杂 CAP 发生率更高，且与心源性栓塞或小血管卒中和大血管卒中等综合参考组相比，CS 中的复杂 CAP 发生率更高。大血管卒中和 NASCET 50%至 69%狭窄患者作为附加比较组。
在 234 名入组患者中，有 196 名患者（CS 患者 n=104，心源性栓塞或小血管卒中和大血管卒中等综合参考组患者 n=79，大血管卒中和 NASCET 50%至 69%狭窄患者 n=19）有完整的颈动脉 MRI 数据。同侧（31%）CS 患者的复杂 CAP 发生率明显高于对侧（12%；p=0.0005）。此外，CS 患者同侧复杂 CAP 的发生率明显高于心源性栓塞或小血管卒中和大血管卒中等综合参考组（15%；p=0.02），明显低于大血管卒中和 NASCET 50%至 69%狭窄组（68%；p=0.003）。同侧 CAP 中的富含脂质和/或坏死核心在 CS 中明显大于心源性栓塞或小血管卒中和大血管卒中等综合参考组（p＜0.05）。
这些发现证实了复杂非狭窄颈动脉斑块作为一种未被充分认识的脑卒中病因的作用。（Carotid Plaque Imaging in Acute Stroke [CAPIAS]；NCT01284933）。
