Giuricin Alessandro, Rapillo Costanza Maria, Arba Francesco, Lombardo Ivano, Sperti Martina, Scrima Giulia Domna, Fainardi Enrico, Nencini Patrizia, Nesi Mascia, Sarti Cristina
NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy.
Stroke Unit, Humanitas Research Hospital, Rozzano Via Manzoni 56, 20089, Rozzano, Italy.
Neurol Sci. 2025 Jan;46(1):239-247. doi: 10.1007/s10072-024-07744-w. Epub 2024 Aug 23.
The latest research in ischaemic stroke pathogenesis is directed to unveil what is inside embolic stroke of undetermined source (ESUS). Whether vulnerable non stenotic carotid plaques (NSTEPS), i.e. atherosclerotic lesions in carotid arteries determining a stenosis lower than 50%, may represent a cause of stroke in ESUS is a matter of debate. We aimed to study the prevalence of NSTEPS in an ESUS population.
We retrospectively identified a consecutive ESUS population admitted to the Stroke-Unit of Careggi Hospital, Italy from 2019 to 2022. Characteristics of atherosclerotic plaques (thickness, ulceration, hypodensity) and their location (ipsilateral versus contralateral to the stroke) were studied on carotid CT angiography (CTA). Follow-up data were recorded up to 24 months after stroke.
We identified 57 ESUS patients with unilateral ischaemic lesions studied with CTA; 53 (93%) had an ipsilateral carotid plaque, 81% contralateral, (p = 0.754) and 74% both. Plaques ipsilateral to stroke were ≥ 3 mm thick in 15 (28%) patients; hypodense in 14 (26%) and ulcerated in 5 (9%). The frequency of hypodensity was higher in ipsilateral compared to contralateral plaques (26% vs. 13%, p = 0.039) and ulceration was around four times more frequent, although not statistically significant (9% vs. 2%, p = 0.219). At follow-up, six patients had stroke recurrence (11%), 2 of them were in the same vascular territory of the former.
Our data suggest that plaques ipsilateral to stroke seem to be more frequently vulnerable and consequently more prone to embolization. Prospective data are needed to clarify the causal role of NSTEPS in ESUS.
缺血性中风发病机制的最新研究旨在揭示不明来源栓塞性中风（ESUS）的内在原因。易损性非狭窄性颈动脉斑块（NSTEPS），即颈动脉中导致狭窄低于50%的动脉粥样硬化病变，是否可能是ESUS中风的一个原因，这是一个有争议的问题。我们旨在研究ESUS人群中NSTEPS的患病率。
我们回顾性地确定了2019年至2022年期间入住意大利卡雷吉医院卒中单元的连续ESUS人群。在颈动脉CT血管造影（CTA）上研究动脉粥样硬化斑块的特征（厚度、溃疡、低密度）及其位置（与中风同侧或对侧）。记录中风后长达24个月的随访数据。
我们确定了57例接受CTA研究的单侧缺血性病变的ESUS患者；53例（93%）有同侧颈动脉斑块，81%有对侧斑块（p = 0.754），74%双侧都有。中风同侧的斑块在15例（28%）患者中厚度≥3mm；14例（26%）为低密度，5例（9%）有溃疡。同侧斑块的低密度频率高于对侧斑块（26%对13%，p = 0.039），溃疡发生率约高四倍，尽管无统计学意义（9%对2%，p = 0.219）。随访时，6例患者发生中风复发（11%），其中2例在先前的同一血管区域。
我们的数据表明，中风同侧的斑块似乎更易损，因此更容易发生栓塞。需要前瞻性数据来阐明NSTEPS在ESUS中的因果作用。
