Chronic ischemic lesions and presence of patent foramen ovale in young adults with embolic stroke of undetermined source - Results of the Young ESUS Patient Registry.

Meinel, Thomas Raphael; Tsiplova, Kate; Taylor, Amanda; Meseguer, Elena; Häusler, Karl Georg; Hart, Robert G; Arnold, Marcel; Perera, Kanjana S (2024). Chronic ischemic lesions and presence of patent foramen ovale in young adults with embolic stroke of undetermined source - Results of the Young ESUS Patient Registry. International journal of stroke, 19(4), pp. 470-477. SAGE 10.1177/17474930231217917

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BACKGROUND

Chronic ischemic lesions (CIL) are frequent findings in patients with acute ischemic stroke, but their phenotypes and relevance in young adults with embolic stroke of undetermined source (Y-ESUS) remains uncertain. We aimed to compare Y-ESUS patients with CIL to those without CIL and assessed the association of CIL and its phenotypes with the presence of patent foramen ovale (PFO).

METHODS

This prospective longitudinal, multicenter cohort study enrolled consecutive patients 50 years and younger with ESUS from 10/2017 to 10/2019 in 41 stroke research centers in 13 countries. Local investigators adjudicated presence and phenotypes of CIL on routine brain imaging (either MRI or CT).

RESULTS

Overall, 535 patients were enrolled (mean age 40.4 (SD 7.3) years, 238 (44%) female). CIL were present in 76/534 (14.2%) patients with a median count CIL count of 1.0 (IQR: 1 to 2), 42/76 (55%) had at least one cortical phenotype and 38/76 (50%) at least one non-cortical phenotype. Y-ESUS with CIL were less often female (32% vs 47% in non-CIL Y-ESUS), were older (mean 43 vs 40 years), had more often hypertension (42% vs 19%), diabetes (17% vs 7%), and hyperlipidemia (34% vs 18%). CIL Y-ESUS were independently associated with lower stroke recurrence (RR 0.17 (0.05-0.61). In Y-ESUS with PFO, CIL were less frequent in probable pathogenic PFO than with probable non-pathogenic PFO (6.1% vs 30% P<0.001).

CONCLUSIONS

One in seven Y-ESUS patients has additional CIL. CIL were associated with several vascular risk factors, lower probability of a pathogenic PFO and lower stroke recurrence.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
UniBE Contributor:	Meinel, Thomas Raphael, Arnold, Marcel
Subjects:	600 Technology > 610 Medicine & health
ISSN:	1747-4949
Publisher:	SAGE
Language:	English
Submitter:	Pubmed Import
Date Deposited:	20 Nov 2023 11:06
Last Modified:	26 Mar 2024 00:13
Publisher DOI:	10.1177/17474930231217917
PubMed ID:	37981572
Uncontrolled Keywords:	Cerebral Infarction Chronic ischemic lesions Clinical trial Ischaemic stroke Lesions MRI PFO covert cerebrovascular disease embolic stroke young stroke
URI:	https://boris.unibe.ch/id/eprint/189169