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首页> 外文期刊>JACC. Cardiovascular imaging. >Prevalence of nonstenosing, complicated atherosclerotic plaques in cryptogenic stroke
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Prevalence of nonstenosing, complicated atherosclerotic plaques in cryptogenic stroke

机译：隐源性卒中中非压迫性，复杂性动脉粥样硬化斑块的患病率

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Objectives: Our goal was to assess the prevalence of complicated American Heart Association (AHA) lesion type VI plaques in the carotid arteries of patients with cryptogenic stroke. Background: In up to 40% of ischemic stroke patients, no definite cause can be established despite extensive workup (i.e., cryptogenic stroke). To test the hypothesis if nonstenosing complicated carotid plaques may be the underlying etiology in some of these patients, we used high-resolution black-blood carotid magnetic resonance imaging (MRI), which can quantitatively assess plaque composition and morphology with good correlation to histopathology. Specifically, we focused on AHA type VI plaques, which are characterized by hemorrhage, thrombus, or fibrous cap rupture. Methods: Thirty-two consecutive patients (22 male; mean age 71.7 ± 11.9 years) with cryptogenic stroke and nonstenosing (<50%) eccentric carotid plaques were recruited from a single stroke unit. All patients underwent extensive clinical workup (brain MRI, duplex sonography, electrocardiography and Holter monitoring, transthoracic and transesophageal echocardiography, and laboratory investigations) to exclude other causes of stroke. All patients received a black-blood carotid MRI at 3-T with fat-saturated pre- and post-contrast T-1-, proton density-, and T-2-weighted and time-of-flight images using surface coils and parallel imaging techniques. Prevalence of AHA type VI plaque was determined in both carotid arteries on the basis of previously published MRI criteria. Results: AHA type VI plaques were found in 12 of 32 arteries (37.5%) ipsilateral to the stroke, whereas there were no AHA type VI plaques contralateral to the stroke (p = 0.001). The most common diagnostic feature of AHA type VI plaques was intraplaque hemorrhage (75%), followed by fibrous plaque rupture (50%) and luminal thrombus (33%). Conclusions: This pilot study suggests that arterio-arterial embolism from complicated, nonstenosing carotid atherosclerotic plaques may play a role in a subgroup of patients previously diagnosed with cryptogenic stroke. To further evaluate the significance of AHA type VI plaques in cryptogenic stroke, future studies will have to analyze both clinical and imaging follow-up data, including event rates for secondary strokes.
机译：目的：我们的目的是评估隐源性中风患者颈动脉中复杂的美国心脏协会（AHA）VI型斑块的患病率。背景：在多达40％的缺血性中风患者中，尽管进行了广泛的检查（即隐源性中风），仍无法确定明确的原因。为了检验假说，是否狭窄的复杂颈动脉​​斑块可能是其中某些患者的潜在病因，我们使用了高分辨率的黑血颈动脉磁共振成像（MRI），该技术可以定量评估斑块的组成和形态，并与组织病理学有很好的相关性。具体来说，我们集中于AHA VI型斑块，其特征在于出血，血栓或纤维帽破裂。方法：从单个卒中单元招募了32例连续患者（22例男性，平均年龄71.7±11.9岁），患有隐源性卒中和非狭窄性（<50％）偏心颈动脉斑块。所有患者均接受了广泛的临床检查（脑MRI，双工超声，心电图和动态心电图监测，经胸和经食道超声心动图以及实验室检查），以排除中风的其他原因。所有患者均在3-T时接受了黑血颈MRI，并通过表面线圈和平行成像对脂肪饱和的T-1和T-1，质子密度和T-2加权和飞行时间造影剂进行了对比。成像技术。根据先前公布的MRI标准，确定两条颈动脉的AHA VI型斑块的患病率。结果：在卒中同侧的32支动脉中有12支发现了AHA VI型斑块（37.5％），而在卒中对侧没有发现AHA VI型斑块（p = 0.001）。 AHA VI型斑块最常见的诊断特征是斑块内出血（75％），其次是纤维斑块破裂（50％）和腔内血栓（33％）。结论：这项初步研究表明，来自复杂的，非狭窄性颈动脉粥样硬化斑块的动脉栓塞可能在先前诊断为隐源性中风的患者亚组中起作用。为了进一步评估AHA VI型斑块在隐源性卒中中的重要性，未来的研究将必须分析临床和影像学随访数据，包括继发性卒中的发生率。

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