ArticleJournal of the American Heart Association2022
Atherosclerosis as a Potential Cause of Deep Embolic Stroke of Undetermined Source: A 3T High-Resolution Magnetic Resonance Imaging Study.
Article in Journal of the American Heart Association, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed, 9 citations in OpenAlex.
- Genetic Insights Into Cryptogenic Stroke: From Etiologic Heterogeneity to Clinical Translation.Journal of stroke · 2026Review
- High Resolution Magnetic Resonance Vessel Wall Imaging: A Valuable Addition to Stroke Work-Up.European journal of neurology · 2026Article
- Supracardiac Atherosclerotic Lesions in Embolic Stroke of Undetermined Source: Predicting Stroke Recurrence and Enhancing Secondary Prevention Strategies.Journal of the American Heart Association · 2025Article
- LASSO-Nomogram model for ultrasound-atherosclerosis correlation and diagnostic verification in anterior circulation.Frontiers in neurology · 2025Article
- Age-dependent sex differences in non-stenotic intracranial plaque of embolic stroke of undetermined source.Scientific reports · 2023Article
- MRI-based risk stratification for recurrent ischemic stroke in embolic stroke of undetermined source.Annals of clinical and translational neurology · 2023Article
- Arterial Hypertension and Its Consequences Are the Main Predictors of Embolic Stroke of Undetermined Source.Disease markers · 2023Article
- Napkin-ring sign plaques are associated with clinical outcome in patients with acute ischemic stroke after endovascular therapy.Frontiers in neurologyArticle
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background The potential causes or sources of embolic stroke of undetermined source (ESUS) vary. This study aimed to investigate the main cause of deep ESUS by evaluating nonstenotic intracranial atherosclerotic plaque. Methods and Results We retrospectively screened consecutive patients with unilateral anterior circulation ESUS. After excluding the patients with possible embolism from an extracranial artery such as aortic arch plaque, carotid plaque, and so on, the enrolled patients with ESUS were categorized into 2 groups: deep ESUS and cortical with/without deep ESUS. All patients underwent intracranial high-resolution magnetic resonance imaging to assess the characteristics of nonstenotic intracranial atherosclerotic plaque. Biomarkers of atrial cardiopathy (ie, P-wave terminal force in lead V1 on ECG, NT-proBNP [N-terminal pro-brain natriuretic peptide] and left atrial diameter) were collected. A total of 155 patients with ipsilateral nonstenotic intracranial atherosclerotic plaque were found, with 76 (49.0%) in deep ESUS and 79 (51.0%) in cortical with/without deep ESUS. We found more prevalent plaque in the M1 segment of the middle cerebral artery and the ostia of the perforator, with a smaller remodeling index plaque burden, and less frequent occurrence of complicated plaque in deep ESUS versus cortical with/without deep ESUS. Higher BNP (brain natriuretic peptide) levels and a higher prevalence of atrial cardiopathy in cortical with/without deep ESUS versus deep ESUS. Moreover, the discrimination of vulnerable plaque for predicting ESUS was significantly enhanced after adjusting for or further excluding patients with deep ESUS. Conclusions The current study provides the first high-resolution magnetic resonance imaging evidence that cortical with/without deep ESUS and deep ESUS should be 2 distinct entities and that atherosclerosis, not embolism, might be the main cause of deep ESUS.
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