Li Ting, Liu Hui, Wang Lijuan, Su Xiaolei, Hu Qiongling, Li Kang
Department of Radiology, The First People's Hospital of Jintang County, Chengdu 610000 Sichuan Province, China.
Department of Radiology, Chongqing General Hospital, Chongqing University, Chongqing 401147, China.
Eur J Radiol. 2025 Jun;187:112097. doi: 10.1016/j.ejrad.2025.112097. Epub 2025 Apr 5.
Ischemic stroke is a significant cause of death and disability. Embolic Stroke of Undetermined Source (ESUS) accounts for a large proportion of acute ischemic strokes. A clear etiology is crucial for the treatment and prevention of stroke. The pathogenic mechanism of non-stenotic carotid plaque (NSCP) in ESUS is not yet fully understood. This study used computed tomographic angiography (CTA) to assess the correlation between NSCP and ESUS.
Eighty-one patients with unilateral anterior circulation ESUS were retrospectively enrolled between June 2020 and June 2022. The prevalence of NSCP, degree of stenosis, plaque thickness, plaque type, plaque irregularity, plaque ulceration, focal areas of hypodensity within the plaque, and positive remodeling were evaluated in both carotid arteries on CTA. Univariate and multivariate logistic regression were used to determine the relationship between NSCP, plaque characteristics, and ipsilateral stroke.
Among 81 patients with unilateral anterior circulation ESUS, the incidence of NCSP was significantly higher in the ipsilateral carotid artery than in the contralateral side (76.5 % vs. 60.5 %, P = 0.028). Plaque type, plaque thickness, plaque thickness >3 mm, and focal areas of hypodensity within the plaque were remarkably different between two sides of carotid plaques (all P < 0.05). In addition, multifactorial logistic regression showed that intraplaque hypodensity (aOR = 6.449 [95 % CI, 1.818-22.878]) and greater plaque thickness (aOR = 2.476 [95 % CI, 1.14-5.38]) were significantly associated with ESUS.
The prevalence of NSCP ipsilateral to stroke is higher in ESUS patients, and more complex plaque features were found on the ipsilateral side. Greater plaque thickness and hypodensity within the plaque were significantly associated with ESUS, and these plaques may be an important embolization source of ESUS.
缺血性中风是导致死亡和残疾的重要原因。不明来源栓塞性中风（ESUS）在急性缺血性中风中占很大比例。明确病因对于中风的治疗和预防至关重要。ESUS中非狭窄性颈动脉斑块（NSCP）的致病机制尚未完全明确。本研究采用计算机断层血管造影（CTA）评估NSCP与ESUS之间的相关性。
回顾性纳入2020年6月至2022年6月期间81例单侧前循环ESUS患者。通过CTA评估双侧颈动脉中NSCP的患病率、狭窄程度、斑块厚度、斑块类型、斑块不规则性、斑块溃疡、斑块内低密度灶以及阳性重塑情况。采用单因素和多因素逻辑回归分析来确定NSCP、斑块特征与同侧中风之间的关系。
在81例单侧前循环ESUS患者中，同侧颈动脉NCSP的发生率显著高于对侧（76.5%对60.5%，P = 0.028）。颈动脉斑块两侧的斑块类型、斑块厚度、斑块厚度>3 mm以及斑块内低密度灶存在显著差异（均P < 0.05）。此外，多因素逻辑回归分析显示，斑块内低密度（调整后比值比[aOR]=6.449 [95%置信区间（CI），1.818 - 22.878]）和更大的斑块厚度（aOR = 2.476 [95% CI，1.14 - 5.38]）与ESUS显著相关。
ESUS患者中风同侧NSCP的患病率更高，且同侧发现更复杂的斑块特征。更大的斑块厚度和斑块内低密度与ESUS显著相关，这些斑块可能是ESUS的重要栓塞来源。
