Boot Esther M, Meijer Frederick J A, Pegge Sjoert, Teeselink Sjan, Schellekens Mijntje Mi, Ekker Merel S, Verhoeven Jamie I, Verburgt Esmée, Immens Maikel, Hilkens Nina, de Leeuw Frank-Erik, Tuladhar Anil M
Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands.
Department of Radiology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands.
Eur Stroke J. 2025 Jun 12:23969873251343828. doi: 10.1177/23969873251343828.
We examined the prevalence and the characteristics of vessel wall (VW) lesions in young stroke patients and their relation to recurrent vascular events. We hypothesize that having VW lesions is associated with an increased risk on recurrent vascular events.
Single-center prospective study of participants aged 18-50 years, with a transient ischemic attack (TIA) or ischemic stroke, who underwent high-resolution 3T magnetic resonance imaging (HR-MRI) with VW imaging. We included 10 controls with symptoms diagnosed as stroke mimics. The HR-MRI scans were reviewed by two neuroradiologists blinded for clinical information. Follow-up was conducted via telephone interviews. Recurrent vascular events were defined as TIA, cerebral stroke, myocardial infarctions, revascularization procedures, or vascular death.
We included 158 participants (median age: 41.5 years, IQR 33.0-46.4); 75 (47.5%) of whom were women. Of these, 44 (27.8%) participants had 81 VW lesions, primarily characterized by VW enhancement (74.1%). 86.4% of VW lesions were located in the corresponding ischemic territory, and 48.6% showed no MRA abnormalities. Almost half of the VW lesions were found in the rare causes subgroup, while 13.6% of the "cryptogenic" subgroup showed VW enhancement. VW lesions were not significantly associated with an increased risk of recurrent vascular events (HR 2.2, 95% CI: 0.7-6.6).
One in four young stroke patients have VW lesions, which were not related to an increased risk of recurrent vascular events. VW lesions were seen across all TOAST categories and were not specific to one stroke cause. Further research is needed to investigate the diagnostic and prognostic value of VW lesions in young stroke patients.
我们研究了年轻卒中患者血管壁（VW）病变的患病率、特征及其与复发性血管事件的关系。我们假设存在VW病变与复发性血管事件风险增加相关。
对年龄在18至50岁、有短暂性脑缺血发作（TIA）或缺血性卒中且接受了VW成像的高分辨率3T磁共振成像（HR-MRI）的参与者进行单中心前瞻性研究。我们纳入了10名被诊断为疑似卒中症状的对照者。HR-MRI扫描由两名对临床信息不知情的神经放射科医生进行评估。通过电话访谈进行随访。复发性血管事件定义为TIA、脑卒、心肌梗死、血运重建手术或血管性死亡。
我们纳入了158名参与者（中位年龄：41.5岁，四分位间距33.0 - 46.4）；其中75名（47.5%）为女性。在这些参与者中，44名（27.8%）有81处VW病变，主要特征为VW强化（74.1%）。86.4%的VW病变位于相应的缺血区域，48.6%未显示MRA异常。几乎一半的VW病变见于罕见病因亚组，而“隐源性”亚组中有13.6%显示VW强化。VW病变与复发性血管事件风险增加无显著关联（风险比2.2，95%置信区间：0.7 - 6.6）。
四分之一的年轻卒中患者有VW病变，这与复发性血管事件风险增加无关。VW病变在所有TOAST分类中均可见，并非特定于某一种卒中病因。需要进一步研究以探讨VW病变在年轻卒中患者中的诊断和预后价值。
