Cardiovascular MRI: A valuable tool to detect cardiac source of emboli in cryptogenic ischemic strokes

Mohammad, Yousef; Alhoqbani, Tariq; Alfaqih, Rashed; Altamimi, Lamees A.; Alotaibi, Abdullah; Almousa, Abdulelah M.; Shaer, Fayez El; Hussain, Raja Rizwan

doi:10.1002/brb3.1620

Cited by 5 publications

(11 citation statements)

References 28 publications

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Section: Resultsmentioning

confidence: 99%

“…Among 6 MR studies, 8 , 9 , 17 , 28 , 48 , 49 5 reported when patients were imaged (within 24 hours 9 to 1 week 49 of symptom onset). Four studies imaged at 3 Tesla, 8 , 9 , 28 , 48 1 at 1.5 Tesla 49 , and 1 used both 1.5 and 3 Tesla 17 . Techniques included 4‐dimensional flow to assess extent of retrograde aortic blood flow, 9 , 48 aortic vessel wall/plaque signal, 9 , 17 , 28 , 48 , 49 Cine of plaques ≥4 mm to detect mobile plaque components, 28 and aortic lumenography with contrast‐enhanced or dynamic time‐resolved magnetic resonance angiography with interleaved stochastic trajectories techniques.…”

Section: Resultsmentioning

confidence: 99%

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Imaging Biomarkers and Prevalence of Complex Aortic Plaque in Cryptogenic Stroke: A Systematic Review

Sakai,

Cao,

Rubin

et al. 2023

JAHA

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Background Complex aortic plaque (CAP) is a potential embolic source in patients with cryptogenic stroke (CS). We review CAP imaging criteria for transesophageal echocardiogram (TEE), computed tomography angiography (CTA), and magnetic resonance imaging and calculate CAP prevalence in patients with acute CS. Methods and Results PubMed and EMBASE databases were searched up to December 2022 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guideline. Two independent reviewers extracted data on study design, imaging techniques, CAP criteria, and prevalence. The Cochrane Collaboration tool and Guideline for Reporting Reliability and Agreement Studies were used to assess risk of bias and reporting completeness, respectively. From 2293 studies, 45 were reviewed for CAP imaging biomarker criteria in patients with acute CS (N=37 TEE; N=9 CTA; N=6 magnetic resonance imaging). Most studies (74%) used ≥4 mm plaque thickness as the imaging criterion for CAP although ≥1 mm (N=1, CTA), ≥5 mm (N=5, TEE), and ≥6 mm (N=2, CTA) were also reported. Additional features included mobility, ulceration, thrombus, protrusions, and assessment of plaque composition. From 23 prospective studies, CAP was detected in 960 of 2778 patients with CS (0.32 [95% CI, 0.24–0.41], I 2 =94%). By modality, prevalence estimates were 0.29 (95% CI, 0.20–0.40; I 2 =95%) for TEE; 0.23 (95% CI, 0.15–0.34; I 2 =87%) for CTA and 0.22 (95% CI, 0.06–0.54; I 2 =92%) for magnetic resonance imaging. Conclusions TEE was commonly used to assess CAP in patients with CS. The most common CAP imaging biomarker was ≥4 mm plaque thickness. CAP was observed in one‐third of patients with acute CS. However, high study heterogeneity suggests a need for reproducible imaging methods.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Imaging Biomarkers and Prevalence of Complex Aortic Plaque in Cryptogenic Stroke: A Systematic Review

Sakai,

Cao,

Rubin

et al. 2023

JAHA

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“…Other modalities such as nonobstructive general angioscopy have the possibility to detect aortic plaques in the aortic arch more accurately than TEE and might help to diagnose atheromatous plaques and embolic materials in the distal ascending aorta which could not be detected on TEE, 15 however nonobstructive general angioscopy is an invasive procedure and the technique still require further evaluation regarding its feasibility. Other cardiovascular images such as CT angiography 16 or MRI 17 are also useful for detecting embolic sources including aortic atherosclerosis. CT angiography is useful for detecting plaque location, size, calcification with contrast, but is less appropriate for patients with renal dysfunction.…”

Section: Discussionmentioning

confidence: 99%

3‐D transesophageal echocardiography aids in assessment of embolic stroke due to aortic atherosclerotic plaque: A case series

Wen,

Naqvi

2024

Echocardiography

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Atherosclerosis is the most common cause of heart disease and stroke. Plaque thickness ≥4 mm in the ascending aorta or aortic arch is strongly correlated with cerebral embolic events and ischemic stroke. However, despite imaging workup, the cause of embolic stroke remains unidentified in many patients. Transesophageal echocardiography (TEE) is the preferred echocardiographic method for the evaluation of cardiac source of emboli. 2D TEE imaging evaluates aortic root and aortic arch in a single plane or two planes with biplane imaging. However, 2D TEE often fails to detect mobile or complex components in the ascending aorta and aortic arch plaques. The routine availability of 3D TEE in current ultrasound systems may significantly improve the assessment of aortic plaques as a potential embolic source. In this case series, we present four consecutive patients with stroke who underwent TEE by a single cardiologist for possible cardioembolic source. Some of these patients may have been labelled as “cryptogenic stroke” or “embolic stroke of undetermined source” (ESUS) due to the presence of insignificant or nonmobile ascending aortic or aortic arch plaques on 2D TEE imaging. In our four consecutive patients with ESUS who underwent TEE by a single operator, 3D TEE showed complex aortic arch plaques with ulceration with mobile components and established these plaques as the likely source of embolic stroke.

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“…At present, there is no gold standard for the diagnosis of ASA. It has been found that the local tumor-like projection towards a atrium ≥10 mm in the middle of the atrial septum is more suitable for the diagnosis of ASA [11][12] . The occurrence of ASA may be due to the pressure difference between the left and right atrium, or may be due to the weak development of fibrous connective tissue in the oval atrial septum, which leads to the lateral expansion of the atrial septum with low pressure [13][14] .…”

Section: Discussionmentioning

confidence: 99%

Effect of atrial septal dilation tumor and patent foramen rotundus on cryptogenic ischemic stroke in young and middle-aged patients

Ling¹,

Xie²

2022

Afr H. Sci.

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Objective: To investigate the effect of atrial septal aneurysm (ASA) and patent foramen ovale (PFO) on cryptogenic ischemic stroke in young and middle-aged patients. Methods: A case-control study was conducted to select 96 young and middle-aged patients with cryptogenic ischemic stroke in the Department of Neurology of our hospital from January 2015 to January 2020 (observation group). A total of 192 patients with non-ischemic stroke were selected as the control group. The clinicadata and transthoracic echocardiography (cTTE) results were compared between the two groups. Results: The ASA depth and tumor wall thickness in the observation group were 15.50 (12.40, 19.80) mm and 3.90 (2.80,4.50) mm, respectively, which were significantly higher than those in the control group ( P < 0.05 ). Logistic regression analysis showed that PFO, and PFO combined with ASA were the influencing factors of cryptogenic ischemic stroke in middle-aged and young people OR = 1.923 and 1.384, P < 0.05 ). Conclusion: Atrial septal aneurysm combined with PFO and PFO are independent influencing factors factor for the occurrence of cryptogenic ischemic stroke in young and middle-aged people, which is worthy of further study. Keywords: Atrial septal aneurysm; Cryptogenic ischemic stroke; Influencing factors; Patent foramen ovale; Young and middle-aged.

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Cardiovascular MRI: A valuable tool to detect cardiac source of emboli in cryptogenic ischemic strokes

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 5 publications

References 28 publications

Imaging Biomarkers and Prevalence of Complex Aortic Plaque in Cryptogenic Stroke: A Systematic Review

Imaging Biomarkers and Prevalence of Complex Aortic Plaque in Cryptogenic Stroke: A Systematic Review

3‐D transesophageal echocardiography aids in assessment of embolic stroke due to aortic atherosclerotic plaque: A case series

Effect of atrial septal dilation tumor and patent foramen rotundus on cryptogenic ischemic stroke in young and middle-aged patients

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