Association Between Carotid Artery Perivascular Fat Density and Embolic Stroke of Undetermined Source

Abstract

AimThis study aims to retrospectively evaluate the association between pericarotid inflammation and the presence of embolic stroke of undetermined source (ESUS).MethodsIn total, 126 patients with ESUS and 118 patients with ischemic stroke from large artery atherosclerosis (LAA) were enrolled. All the patients underwent brain MRI and a neck CT angiography (CTA) examination. Reviewers were blinded to infarct location and stroke cause. Paired t-tests assessed within-subjects differences in mean Hounsfield units (HUs) in carotid perivascular fat between the cerebral infarction side and contralateral side for ESUS and LAA ischemic stroke cases. The unpaired Student's t-test was used to assess between-subjects differences in mean HUs between ESUS and LAA ischemic stroke cases.ResultsIn both the ESUS cases and LAA ischemic stroke cases, the pericarotid fat density around the carotid artery ipsilateral to the stroke significantly increased compared with contralateral stroke position in both the groups (ESUS cases −56.31 ± 18.70 vs. −67.31 ± 20.01, p = 0.000; LAA ischemic stroke cases −51.62 ± 19.95 vs. −64.58 ± 22.68, p = 0.000). However, there was no significant difference in ipsilateral and contralateral positions to infarct between ESUS cases and LAA ischemic stroke cases (ipsilateral to infarct −56.31 ± 18.70 vs. −51.62 ± 19.95, p = 0.059; contralateral to infarct −67.31 ± 20.01 vs. −64.58 ± 22.68, p = 0.320).ConclusionWe found increased density in the fat surrounding carotid artery ipsilateral to stroke compared with contralateral in ESUS, suggesting the presence of an inflammatory reaction that extends beyond the vessel lumen in patients with ESUS with a risk factor profile similar to LAA strokes.

Parapharyngeal Fat Tissue Accumulation and Its Association with Carotid Intima-Media Thickness in Discordant Twin Pairs

“…However, there have been a few studies investigating the possible effects of PVAT surrounding the carotid arteries. Hu et al found an elevated density of carotid artery PVAT on CT scans in patients with embolic stroke of unknown source [26]. Zhang et al found an independent association between carotid artery PVAT density and intraplaque hemorrhage analyzing CT and MRI scans [27].…”

Associations between preprocedural carotid artery perivascular fat density and early in-stent restenosis after carotid artery stenting

“…Moreover, it has been shown that the inflammatory changes in PVAT surrounding the carotid artery can be evaluated using computed tomography angiography (CTA) as areas of increased perivascular fat density (PFD) [ 10 ]. Recent studies have provided evidence that the increased PFD of the carotid artery is associated with cerebrovascular ischemic symptoms, ischemic stroke from an undetermined embolic source, and the occurrence of intraplaque hemorrhage [ [11] , [12] , [13] ]. A thorough search of the literature shows that there is no incontrovertible evidence to show that PFD is related to early ISR after CAS.…”