1. Intracranial Atherosclerotic Plaque as a Potential Cause of Embolic Stroke of Undetermined Source
- Author
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Cheng Xia, Hui-Sheng Chen, George Ntaios, Lin Tao, Benqiang Yang, Xiaowen Hou, and Xiao-Qiu Li
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Fibrous cap ,Magnetic resonance imaging ,Odds ratio ,030204 cardiovascular system & hematology ,medicine.disease ,Confidence interval ,Embolic stroke ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Internal medicine ,medicine ,Cardiology ,In patient ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Stroke ,Artery - Abstract
Background 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. Objectives 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. Methods 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. Results 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 Conclusions The present study supports an etiologic role of high-risk nonstenotic intracranial plaque in ESUS.
- Published
- 2021