Department of Neurology, General Hospital of Northern Theater Command, Shen Yang, China.
Department of Radiology, General Hospital of Northern Theater Command, Shen Yang, China.
J Am Coll Cardiol. 2021 Feb 16;77(6):680-691. doi: 10.1016/j.jacc.2020.12.015.
Previous studies investigated the potential mechanism of embolic stroke of undetermined source (ESUS) from extracranial artery plaque, but there has been no study other than a case report on high-risk intracranial plaque in ESUS.
The aim of this study was to investigate the issue by evaluating the morphology and composition of intracranial plaque in patients with ESUS and small-vessel disease (SVD) using 3.0-T high-resolution magnetic resonance imaging.
Two hundred forty-three consecutive patients with ESUS and 160 patients with SVD-associated stroke between January 2015 and December 2019 were retrospectively enrolled. Multidimensional parameters involving the presence of plaque on both sides, including remodeling index (RI), plaque burden, presence of discontinuity of plaque surface, thick fibrous cap, intraplaque hemorrhage, and complicated American Heart Association type VI plaque at the maximal luminal narrowing site, were evaluated using intracranial high-resolution magnetic resonance imaging.
Among 243 patients with ESUS, the prevalence of intracranial plaque was much higher in the ipsilateral than the contralateral side (63.8% vs. 42.8%; odds ratio [OR]: 5.25; 95% confidence interval [CI]: 2.83 to 9.73), a finding that was not evident in patients with SVD (35.6% vs. 30.6%; OR: 2.14; 95% CI: 0.87 to 5.26; p = 0.134). Logistic analysis showed that RI was independently associated with ESUS in model 1 (OR: 2.329; 95% CI: 1.686 to 3.217; p < 0.001) and model 2 (OR: 2.295; 95% CI: 1.661 to 3.172; p < 0.001). RI alone with an optimal cutoff of 1.162, corresponding to an area under the curve of 0.740, had good diagnostic efficiency for ESUS.
The present study supports an etiologic role of high-risk nonstenotic intracranial plaque in ESUS.
先前的研究调查了源自颅外动脉斑块的不明来源栓塞性卒中（ESUS）的潜在机制，但除了一例病例报告外，尚无关于 ESUS 中高危颅内斑块的研究。
本研究旨在通过使用 3.0-T 高分辨率磁共振成像评估 ESUS 和小血管疾病（SVD）患者颅内斑块的形态和成分来探讨这个问题。
回顾性纳入 2015 年 1 月至 2019 年 12 月期间连续 243 例 ESUS 患者和 160 例 SVD 相关卒中患者。使用颅内高分辨率磁共振成像评估双侧斑块存在的多维度参数，包括重塑指数（RI）、斑块负荷、斑块表面连续性中断、厚纤维帽、斑块内出血和最大管腔狭窄部位的复杂美国心脏协会 VI 型斑块，。
在 243 例 ESUS 患者中，同侧颅内斑块的发生率明显高于对侧（63.8%对 42.8%；优势比[OR]：5.25；95%置信区间[CI]：2.83 至 9.73），而在 SVD 患者中则不然（35.6%对 30.6%；OR：2.14；95%CI：0.87 至 5.26；p=0.134）。Logistic 分析显示，在模型 1（OR：2.329；95%CI：1.686 至 3.217；p<0.001）和模型 2（OR：2.295；95%CI：1.661 至 3.172；p<0.001）中，RI 独立与 ESUS 相关。RI 单独的最佳截断值为 1.162，曲线下面积为 0.740，对 ESUS 具有良好的诊断效率。
本研究支持非狭窄性颅内高危斑块在 ESUS 中的病因作用。
