Impact of high-resolution intracranial vessel wall magnetic resonance imaging on diagnosis in patients with embolic stroke of unknown source.

Autor: Simaan N; Departments of Neurology, Ziv Medical Center, Zefat, Israel., Shalabi F; Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel., Schwartzmann Y; Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel., Jubeh T; Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel., Parag Y; Departments of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel., Honig A; Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel., Metanis I; Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel., Joubran H; Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel., Magadlla J; Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel., Gomori JM; Departments of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel., Cohen JE; Departments of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel., Leker RR; Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. Electronic address: leker@hadassah.org.il.
Jazyk: angličtina
Zdroj: Journal of the neurological sciences [J Neurol Sci] 2023 Nov 15; Vol. 454, pp. 120863. Date of Electronic Publication: 2023 Oct 30.
DOI: 10.1016/j.jns.2023.120863
Abstrakt: Background: The mechanism responsible for stroke in patients with embolic stroke of unknown source (ESUS) often remains unknown despite extensive investigations. We aimed to test whether high-resolution intracranial vessel wall MR imaging (icVWI) can add to the diagnostic yield in these patients.
Patients and Methods: Patients with ESUS were prospectively included into an ongoing registry. Patients that underwent icVWI as part of their diagnostic workup were compared to those that did not have an icVWI. Patients with icVWI positive for intracranial vulnerable plaques were than compared to those without evidence of plaque vulnerability on VWI.
Results: A total of 179 patients with ESUS were included and 48 of them (27%) underwent icVWI. Patients that had an icVWI scan were significantly younger, had lower rates of ischemic heart disease and prior disability as well as significantly lower stroke severity. On regression analysis the only factor that remained associated with not obtaining an icVWI scan was increasing age (Odds ratio [OR] 0.97/year, 95% confidence intervals [CI] 0.95-0.97). Among patients that had an icVWI scan 28 (58%) had evidence of plaque enhancement on VWI in the same distribution of the stroke and the remaining 20 studies were negative. The relative proportion of stroke presumed to be secondary to intracranial non-stenotic atheromatous disease increased from 15% in patients without icVWI scans to 58% among patients with icVWI scans (p = 0.001). On regression analysis the only factor that was associated with vulnerable plaques on icVWI was smoking (OR 11.05 95% CI 1.88-65.17).
Conclusions: icVWI can add significant information relevant to stroke pathogenesis and treatment in patients with ESUS and a negative initial exhaustive diagnostic workup.
(Copyright © 2023 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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