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Underlying embolic and pathologic differentiation by cerebral microbleeds in cryptogenic stroke
Muneaki Kikuno1,2, Yuji Ueno3, Takahiro Shimizu4
1Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
Background:
Cryptogenic stroke encompasses diverse emboligenic mechanisms and pathogeneses. Cerebral microbleeds (CMBs) occur differently among stroke subtypes. The association of CMBs with cryptogenic stroke is essentially unknown.
Methods:
CHALLENGE ESUS/CS (Mechanisms of Embolic Stroke Clarified by Transesophageal Echocardiography for ESUS/CS) is a multicenter registry with comprehensive data including gradient-echo T2*-weighted magnetic resonance imaging of cryptogenic stroke patients who underwent transesophageal echocardiography. Patients' clinical characteristics were compared according to the presence and location of CMBs.
Results:
A total of 661 patients (68.7 ± 12.7 years; 445 males) were enrolled, and 209 (32%) had CMBs. Age (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.00-1.04, p = 0.020), male sex (OR 1.85, 95% CI 1.18-2.91, p = 0.007), hypertension (OR 1.71, 95% CI 1.03-2.86, p = 0.039), chronic kidney disease (OR 1.64, 95% CI 1.11-2.43, p = 0.013), deep and subcortical white matter hyperintensity (OR 1.82, 95% CI 1.16-2.85, p = 0.009), and periventricular hyperintensity (OR 2.18, 95% CI 1.37-3.46, p = 0.001) were independently associated with the presence of CMBs. Aortic complicated lesions (OR 1.78, 95% CI 1.12-2.84, p = 0.015) were associated with deep and diffuse CMBs, whereas prior anticoagulant therapy (OR 7.88, 95% CI, 1.83-33.9, p = 0.006) was related to lobar CMBs.
Conclusions:
CMBs were common, and age, male sex, hypertension, chronic kidney disease, and cerebral white matter diseases were related to CMBs in cryptogenic stroke. Aortic complicated lesions were associated with deep and diffuse CMBs, while prior anticoagulant therapy was related to lobar CMBs.
Insights
Cerebral microbleeds (CMBs) are common in cryptogenic stroke. Age, male sex, hypertension, kidney disease, and white matter disease are associated with CMBs, with specific links to aortic lesions and anticoagulant therapy.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Research
Background:
- Cryptogenic stroke has diverse causes, and cerebral microbleeds (CMBs) present differently across stroke subtypes.
- The relationship between CMBs and cryptogenic stroke remains largely unexplored.
Purpose of the Study:
- To investigate the prevalence and clinical associations of CMBs in patients with cryptogenic stroke.
- To identify factors associated with the presence and location of CMBs in this population.
Main Methods:
- Utilized the CHALLENGE ESUS/CS multicenter registry, including gradient-echo T2*-weighted MRI.
- Compared clinical characteristics of cryptogenic stroke patients based on the presence and location of CMBs.
Main Results:
- 32% of 661 patients had CMBs. Independent predictors included older age, male sex, hypertension, chronic kidney disease, and white matter hyperintensities.
- Aortic complicated lesions correlated with deep/diffuse CMBs; prior anticoagulant therapy was linked to lobar CMBs.
Conclusions:
- CMBs are frequent in cryptogenic stroke and associated with several clinical factors.
- Specific associations were found between CMB location and aortic lesions or prior anticoagulant use.
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