■许多缺血性中风被诊断为不明来源的栓塞性中风(ESUS)。最近的证据表明,非狭窄颈动脉斑块(nsCP)可能是ESUS风险的重要原因。我们旨在调查ESUS中与nsCP相关的危险因素概况和定义的卒中病因。
■在这项回顾性病例对照研究中,我们调查了由ESUS引起的急性缺血性卒中的连续患者,小血管疾病,或磁共振成像证实的心脏栓塞。血管危险因素的关联年龄,动脉高血压,糖尿病,异常脂蛋白血症,身体质量指数,酒精消费,烟草使用,肾衰竭,使用二元logistic回归分析对存在nsCP的卒中病史进行调查,并进一步按卒中病因和性别进行分层.
■总共,609名患者(中位年龄,76岁;46%的女性)从2018年到2020年接受治疗的人被认为是。在ESUS患者中,与明确的病因相比,性别对nsCP的患病率起更重要的作用.与ESUS的男性患者相比,ESUS的女性患者显示nsCP的几率较低(调整后的优势比,0.36[95%CI,0.15-0.86])。在ESUS的男性患者中,我们观察到年龄(每10年增加调整后的赔率比,2.55[95%CI,1.26-5.17])和高血压(调整后的比值比,2.49[95%CI,0.56-11.1])是nsCP的主要危险因素,而在ESUS女性患者中,烟草使用也特别相关(调整后的比值比,3.71[95%CI,0.61-22.5])。这些结果与位于梗死同侧的nsCP的敏感性分析一致。
■性别差异在ESUS患者的nsCP患病率中起重要作用。这些发现可能对ESUS后有针对性的二级预防管理具有重要意义。
Many ischemic strokes are diagnosed as embolic strokes of undetermined source (ESUS). Recent evidence suggests that nonstenotic carotid plaque (nsCP) may be a substantial contributor to the risk for ESUS. We aimed to investigate the risk factor profile associated with nsCP in ESUS and defined stroke etiologies.
In this retrospective case-control study, we investigated consecutive patients with acute ischemic stroke due to ESUS, small-vessel disease, or cardioembolism proven by magnetic resonance imaging. The association of vascular risk factors age, arterial hypertension, diabetes, dyslipoproteinemia, body mass index, alcohol consumption, tobacco use, kidney failure, and history of stroke with the presence of nsCP was investigated using binary logistic regression analysis and further stratified by stroke etiology and sex.
In total, 609 patients (median age, 76 years; 46% women) who were treated from 2018 to 2020 were considered. In patients with ESUS, sex played a more important role for the prevalence of nsCP than in defined etiologies. Female patients with ESUS had lower odds of exhibiting nsCP compared with male patients with ESUS (adjusted odds ratio, 0.36 [95% CI, 0.15-0.86]). In male patients with ESUS, we observed that age (adjusted odds ratio per 10-year increase, 2.55 [95% CI, 1.26-5.17]) and hypertension (adjusted odds ratio, 2.49 [95% CI, 0.56-11.1]) were the main risk factors for nsCP, whereas in female patients with ESUS also tobacco use was particularly relevant (adjusted odds ratio, 3.71 [95% CI, 0.61-22.5]). These results were in line with a sensitivity analysis in nsCP located ipsilateral to the infarct.
Sex differences play an important role in nsCP prevalence in patients with ESUS. These findings may have important implications for the management in targeted secondary prevention following ESUS.