Intracranial Atherosclerotic Plaque as a Potential Cause of Embolic Stroke of Undetermined Source

Atrial cardiopathy and non-stenotic intracranial complicated atherosclerotic plaque in patients with embolic stroke of undetermined source

“…We used the same ESUS cohort, which has been reported in detail in our recent study 19. Briefly, between January 2015 and December 2019, we enrolled all consecutive patients with ESUS in unilateral anterior circulation (that was supplied by middle cerebral artery or/and anterior cerebral artery based on diffusion weighted image (DWI) where the lesion was not lacunar, defined as a subcortical infarct ≤2 cm in largest dimension) within 1 week from onset to high-resolution MRI (HR-MRI); ESUS was defined according to the Cryptogenic Stroke/ESUS International Working Group criteria 1.…”

“…Aortic, extracranial and intracranial non-stenotic atherosclerotic plaques, collectively described as supracardiac atherosclerosis, emerged as another remarkable potential embolic source in ESUS 6 15–18. We recently reported that non-stenotic intracranial complicated atherosclerotic plaques (NICAPs) were more prevalent in the ipsilateral side to the infarct rather than contralateral, supporting an aetiologic role of NICAP in ESUS 19…”

Non-stenotic Carotid Plaques in Embolic Stroke of Unknown Source

“…There are several ongoing projects exploring biomarkers in patients with ESUS or cryptogenic stroke, notably the Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Etiology, Triggers, and Outcome study (SECRETO, NCT01934725) ( 95 ), the Carotid Plaque Imaging in Acute Stroke study (CAPIAS, NCT01284933) ( 35 ), and the Biomarkers of Acute Stroke Etiology study (BASE, NCT02014896) ( 96 ). Efforts to establish a causal relationship between non-stenotic carotid stenosis and ESUS using biomarkers and multimodal vascular imaging in well-phenotyped prospective cohorts will also benefit from research aiming to identify alternative causes of stroke in patients with ESUS ( 14 , 68 , 97 – 104 ).…”

“…However, there is now evidence to suggest that ESUS represents a heterogeneous group including patients with various other potential causes of stroke besides atrial fibrillation (7)(8)(9). Such causes include atrial cardiopathy (10), patent foramen ovale (PFO) (11), cancer (12), and non-stenotic plaques affecting the aortic arch or carotid, vertebral, or intracranial arteries (7,13,14). Atrial cardiopathy is a concept referring to a dysfunction of the left atrium that is thought to favor and precede the onset of atrial fibrillation and its eventual detection by electrocardiographic devices.…”

Atrial cardiopathy in embolic stroke of undetermined source

“…rates were not found from oral anticoagulation than from aspirin in ESUS patients by the two recently completed large trials: NAVIGATE ESUS and RE-SPECT ESUS (Diener et al, 2019;Hart et al, 2018), which might be explained by the overlap of potential embolic sources, including atrial cardiopathy, covert AF, left ventricular disease, aortic arch plaque, nonstenosing carotid plaques, patent foramen ovale, cardiac valvular disease, and cancer (Ntaios, 2020;Ntaios, Pearce, et al, 2019;Ntaios, Pearce, et al, 2020;Ntaios, Perlepe, Lambrou, et al, 2019;Ntaios, Weng, et al, 2021;Tao et al, 2021). Patients with ESUS caused by emboli from the heart or venous system may benefit from anticoagulation, while patients with ESUS caused by emboli from atherosclerotic plaques respond better to antiplatelet agents.…”