Goldstein Eric D, Yaghi Shadi
Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI, USA.
Neurohospitalist. 2024 Apr;14(2):166-169. doi: 10.1177/19418744231212999. Epub 2023 Nov 2.
Recent small subcortical infarcts (SSI) are a common radiographic predecessor to lacunar stroke. SSI is comprised of several pathophysiologic processes such as branch atherosclerotic disease (BAD) and lipohyalinosis, both of which have differing outcomes and natural history. Presently, there is not a proven method to determine whether a SSI is due to BAD or lipohyalinosis in non-stenotic vessels. However, high-resolution vessel wall imaging (HRVWI) has been reported in East Asian cohorts. We aimed to use HRVWI to identify individuals with BAD-related SSI in a North American cohort. We performed a cross-sectional study from the Rhode Island Hospital. All patients had a SSI as defined by consensus criteria. The presence of vessel wall enhancement of parent vessels were reviewed by two authors. Standard descriptive statistical techniques were used. Of 28 patients who underwent HRVWI, 7 met criteria for SSI. The median age was 68 years and 3 were female. Parent vessel wall enhancement was present in 2 patients. In our North American cohort, HRVWI was able to dichotomize individuals based on parent vessel wall enhancement suggestive of a BAD-related SSI. Further studies are needed to expand our cohort size and confirm our findings.
近期皮质下小梗死灶（SSI）是腔隙性卒中常见的影像学前驱病变。SSI由多种病理生理过程组成，如分支动脉粥样硬化疾病（BAD）和脂质透明变性，二者具有不同的转归和自然病程。目前，尚无已证实的方法可在非狭窄血管中确定SSI是由BAD还是脂质透明变性所致。然而，东亚队列中已有关于高分辨率血管壁成像（HRVWI）的报道。我们旨在利用HRVWI在北美队列中识别出患有BAD相关SSI的个体。我们在罗德岛医院开展了一项横断面研究。所有患者均符合共识标准定义的SSI。由两位作者对母血管的血管壁强化情况进行评估。采用标准描述性统计技术。在接受HRVWI检查的28例患者中，7例符合SSI标准。中位年龄为68岁，女性3例。2例患者存在母血管壁强化。在我们的北美队列中，HRVWI能够根据提示BAD相关SSI的母血管壁强化情况对个体进行二分。需要进一步研究以扩大我们的队列规模并证实我们的发现。
