Muneaki Kikuno1,2, Yuji Ueno3, Takahiro Shimizu4, Ayako Kuriki5, Yohei Tateishi6, Ryosuke Doijiri7, Yoshiaki Shimada8, Hidehiro Takekawa9, Eriko Yamaguchi7, Masatoshi Koga1, Yuki Kamiya5, Masafumi Ihara10, Akira Tsujino6, Koichi Hirata9, Kazunori Toyoda1, Yasuhiro Hasegawa4, Hitoshi Aizawa2, Nobutaka Hattori11, Takao Urabe8. 1. Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan. 2. Department of Neurology, Tokyo Medical University Hospital, Tokyo, Japan. 3. Department of Neurology, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. yuji-u@juntendo.ac.jp. 4. Department of Neurology, St. Marianna University School of Medicine, Kanagawa, Japan. 5. Department of Neurology, Showa University Koto Toyosu Hospital, Tokyo, Japan. 6. Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan. 7. Department of Neurology, Iwate Prefectural Central Hospital, Iwate, Japan. 8. Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan. 9. Department of Neurology, Dokkyo Medical University, Tochigi, Japan. 10. Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan. 11. Department of Neurology, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Abstract
BACKGROUND: Cryptogenic stroke encompasses diverse emboligenic mechanisms and pathogeneses. Cerebral microbleeds (CMBs) occur differently among stroke subtypes. The association of CMBs with cryptogenic stroke is essentially unknown. METHODS: CHALLENGE ESUS/CS (Mechanisms of Embolic Stroke Clarified by Transesophageal Echocardiography for ESUS/CS) is a multicenter registry with comprehensive data including gradient-echo T2*-weighted magnetic resonance imaging of cryptogenic stroke patients who underwent transesophageal echocardiography. Patients' clinical characteristics were compared according to the presence and location of CMBs. RESULTS: A total of 661 patients (68.7 ± 12.7 years; 445 males) were enrolled, and 209 (32%) had CMBs. Age (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.00-1.04, p = 0.020), male sex (OR 1.85, 95% CI 1.18-2.91, p = 0.007), hypertension (OR 1.71, 95% CI 1.03-2.86, p = 0.039), chronic kidney disease (OR 1.64, 95% CI 1.11-2.43, p = 0.013), deep and subcortical white matter hyperintensity (OR 1.82, 95% CI 1.16-2.85, p = 0.009), and periventricular hyperintensity (OR 2.18, 95% CI 1.37-3.46, p = 0.001) were independently associated with the presence of CMBs. Aortic complicated lesions (OR 1.78, 95% CI 1.12-2.84, p = 0.015) were associated with deep and diffuse CMBs, whereas prior anticoagulant therapy (OR 7.88, 95% CI, 1.83-33.9, p = 0.006) was related to lobar CMBs. CONCLUSIONS: CMBs were common, and age, male sex, hypertension, chronic kidney disease, and cerebral white matter diseases were related to CMBs in cryptogenic stroke. Aortic complicated lesions were associated with deep and diffuse CMBs, while prior anticoagulant therapy was related to lobar CMBs.
BACKGROUND: Cryptogenic stroke encompasses diverse emboligenic mechanisms and pathogeneses. Cerebral microbleeds (CMBs) occur differently among stroke subtypes. The association of CMBs with cryptogenic stroke is essentially unknown. METHODS: CHALLENGE ESUS/CS (Mechanisms of Embolic Stroke Clarified by Transesophageal Echocardiography for ESUS/CS) is a multicenter registry with comprehensive data including gradient-echo T2*-weighted magnetic resonance imaging of cryptogenic strokepatients who underwent transesophageal echocardiography. Patients' clinical characteristics were compared according to the presence and location of CMBs. RESULTS: A total of 661 patients (68.7 ± 12.7 years; 445 males) were enrolled, and 209 (32%) had CMBs. Age (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.00-1.04, p = 0.020), male sex (OR 1.85, 95% CI 1.18-2.91, p = 0.007), hypertension (OR 1.71, 95% CI 1.03-2.86, p = 0.039), chronic kidney disease (OR 1.64, 95% CI 1.11-2.43, p = 0.013), deep and subcortical white matter hyperintensity (OR 1.82, 95% CI 1.16-2.85, p = 0.009), and periventricular hyperintensity (OR 2.18, 95% CI 1.37-3.46, p = 0.001) were independently associated with the presence of CMBs. Aortic complicated lesions (OR 1.78, 95% CI 1.12-2.84, p = 0.015) were associated with deep and diffuse CMBs, whereas prior anticoagulant therapy (OR 7.88, 95% CI, 1.83-33.9, p = 0.006) was related to lobar CMBs. CONCLUSIONS: CMBs were common, and age, male sex, hypertension, chronic kidney disease, and cerebral white matter diseases were related to CMBs in cryptogenic stroke. Aortic complicated lesions were associated with deep and diffuse CMBs, while prior anticoagulant therapy was related to lobar CMBs.
Authors: José Rafael Romero; Sarah R Preis; Alexa Beiser; Charles DeCarli; Anand Viswanathan; Sergi Martinez-Ramirez; Carlos S Kase; Philip A Wolf; Sudha Seshadri Journal: Stroke Date: 2014-04-08 Impact factor: 7.914
Authors: Mukul Sharma; Robert G Hart; Stuart J Connolly; Jackie Bosch; Olga Shestakovska; Kelvin K H Ng; Luciana Catanese; Katalin Keltai; Victor Aboyans; Marco Alings; Jong-Won Ha; John Varigos; Andrew Tonkin; Martin O'Donnell; Deepak L Bhatt; Keith Fox; Aldo Maggioni; Scott D Berkowitz; Nancy Cook Bruns; Salim Yusuf; John W Eikelboom Journal: Circulation Date: 2019-02-26 Impact factor: 29.690
Authors: Duncan Wilson; Gareth Ambler; Keon-Joo Lee; Jae-Sung Lim; Masayuki Shiozawa; Masatoshi Koga; Linxin Li; Caroline Lovelock; Hugues Chabriat; Michael Hennerici; Yuen Kwun Wong; Henry Ka Fung Mak; Luis Prats-Sánchez; Alejandro Martínez-Domeño; Shigeru Inamura; Kazuhisa Yoshifuji; Ethem Murat Arsava; Solveig Horstmann; Jan Purrucker; Bonnie Yin Ka Lam; Adrian Wong; Young Dae Kim; Tae-Jin Song; Maarten Schrooten; Robin Lemmens; Sebastian Eppinger; Thomas Gattringer; Ender Uysal; Zeynep Tanriverdi; Natan M Bornstein; Einor Ben Assayag; Hen Hallevi; Jun Tanaka; Hideo Hara; Shelagh B Coutts; Lisa Hert; Alexandros Polymeris; David J Seiffge; Philippe Lyrer; Ale Algra; Jaap Kappelle; Rustam Al-Shahi Salman; Hans R Jäger; Gregory Y H Lip; Heinrich P Mattle; Leonidas D Panos; Jean-Louis Mas; Laurence Legrand; Christopher Karayiannis; Thanh Phan; Sarah Gunkel; Nicolas Christ; Jill Abrigo; Thomas Leung; Winnie Chu; Francesca Chappell; Stephen Makin; Derek Hayden; David J Williams; M Eline Kooi; Dianne H K van Dam-Nolen; Carmen Barbato; Simone Browning; Kim Wiegertjes; Anil M Tuladhar; Noortje Maaijwee; Christine Guevarra; Chathuri Yatawara; Anne-Marie Mendyk; Christine Delmaire; Sebastian Köhler; Robert van Oostenbrugge; Ying Zhou; Chao Xu; Saima Hilal; Bibek Gyanwali; Christopher Chen; Min Lou; Julie Staals; Régis Bordet; Nagaendran Kandiah; Frank-Erik de Leeuw; Robert Simister; Aad van der Lugt; Peter J Kelly; Joanna M Wardlaw; Yannie Soo; Felix Fluri; Velandai Srikanth; David Calvet; Simon Jung; Vincent I H Kwa; Stefan T Engelter; Nils Peters; Eric E Smith; Yusuke Yakushiji; Dilek Necioglu Orken; Franz Fazekas; Vincent Thijs; Ji Hoe Heo; Vincent Mok; Roland Veltkamp; Hakan Ay; Toshio Imaizumi; Beatriz Gomez-Anson; Kui Kai Lau; Eric Jouvent; Peter M Rothwell; Kazunori Toyoda; Hee-Joon Bae; Joan Marti-Fabregas; David J Werring Journal: Lancet Neurol Date: 2019-05-23 Impact factor: 59.935