Neuroimaging features of antiphospholipid antibody-related stroke compared with atrial fibrillation-related stroke

Abstract

Recognizing the lesion pattern of antiphospholipid antibody-related stroke (aPL-stroke) may contribute to establishing the cause in patients with cryptogenic stroke. We aimed to describe the neuroimaging features of aPL-stroke compared with atrial fibrillation-related stroke (AF-stroke), a major hidden cause of cryptogenic stroke. Using a prospective stroke registry, we identified consecutive aPL- and AF-stroke patients without other potential causes of stroke. Neuroimaging features based on diffusion-weighted imaging and angiographic findings at admission were compared. A total of 56 and 333 patients were included in the aPL- and AF-stroke groups, respectively. aPL-stroke patients more often presented with single small lesions (aPL-stroke, 30.4% vs. AF-stroke, 7.5%, p < 0.001), while the predominant pattern in AF-stroke patients was large territorial lesions (26.8% vs. 56.5%, p < 0.001). aPL-stroke patients had smaller infarct volume (1.58 mL [0.45; 9.41] vs. 11.32 mL [2.82; 33.08], p < 0.001) and less experience of relevant artery occlusion (17.9% vs. 54.7%, p < 0.001). The proportion of multi-territory lesions, an embolic pattern, was similar between the two groups (28.6% vs. 22.8%, p = 0.44). In comparison only including patients with multi-territory lesions as well, aPL-stroke patients showed small lesion dominance and smaller infarct volume. Multivariate analyses showed independent associations between mild neuroimaging features (small lesion prevalence, smaller infarct volume, and absence of relevant artery occlusion) and aPL-stroke. Patterns of small lesion prevalence, small infarct volume, and absence of relevant artery occlusion were suggestive of aPL-stroke rather than AF-stroke. Cryptogenic stroke patients with such neuroimaging features may benefit from aPL testing for a precise diagnosis.

Neurovascular Manifestations of Iron-Deficient Anemia: Narrative Review and Practical Reflections through A Teaching Case

“…Moreover, neuroimaging features of APS-associated stroke are not completely congruent with the presented case. Indeed, an interesting study [7] comparing APS-associated stroke and AF-associated stroke starting from cerebral cryptogenic embolism and in particular multi-territory lesions, shown that the first one has mild neuroimaging features (small lesion prevalence, smaller infarct volume, and absence of relevant artery occlusion). CAS was a meaningful diagnostic hypothesis and several issues may raise it in the context of the diagnostic work-up of cryptogenic embolism [8].…”

Neurovascular Manifestations of Iron-Deficient Anemia: Narrative Review and Practical Reflections through a Teaching Case

“…Moreover, the neuroimaging features of APS-associated stroke are not completely congruent with the presented case. Indeed, an interesting study [ 7 ] comparing APS-associated stroke and AF-associated stroke starting from cerebral cryptogenic embolism and in particular multi-territory lesions showed that the first one has mild neuroimaging features (small lesion prevalence, smaller infarct volume, and absence of relevant artery occlusion).…”

Neurovascular Issues in Antiphospholipid Syndrome: Arterial Vasculopathy from Small to Large Vessels in a Neuroradiological Perspective

“…In the longitudinal evolution of neuroradiological patterns, SVD markers might appear, as in Figure 8 (same patient as in Figure 7 but 8 years later and without new clinical events on anticoagulant treatment). In addition, Figure 6 shows the presence of multiple ischemic lesions in the same arterial territory, and this issue has not been clearly addressed in the multiplicity of lesions described in the abovementioned paper [131]. A different situation is illustrated in Figure 7, where the multiple ischemic lesions are in different vascular territories.…”

“…In addition, Figure 6 shows the presence of multiple ischemic lesions in the same arterial territory, and this issue has not been clearly addressed in the multiplicity of lesions described in the abovementioned paper [131].…”

“…Furthermore, recognizing aPL-stroke could aid in preventing the inappropriate use of direct oral anticoagulants (DOACs) in undiagnosed aPL-stroke patients, given recent reports highlighting DOAC-related risks in APS [128][129][130]. In a recently published series [131] on 129 patients with acute ischemic stroke and positive aPL compared with 333 patients with AF-related acute ischemic stroke, some interesting information has been provided. First, only 56/129 (45.7%) of patients in the aPL group had APS as a cause of stroke; large artery atherosclerosis being the most prominent cause.…”