Clarification of embolic source in ischaemic stroke by non-obstructive general angioscopy

Area of Science:

• Cardiovascular Medicine
• Neurology
• Diagnostic Imaging

Background:

• Aortogenic stroke, a subtype of embolic stroke, lacks proactive diagnostic methods.
• Spontaneously ruptured aortic plaques (SRAPs) are potential embolic sources for ischemic stroke.
• Non-obstructive general angioscopy (NOGA) is a catheter-based technique for visualizing SRAPs.

Purpose of the Study:

• To identify the embolic source of ischemic stroke using NOGA.
• To proactively diagnose aortogenic stroke.

Main Methods:

• 321 patients with acute ischemic stroke were evaluated.
• 25 patients underwent mechanical thrombectomy and NOGA for aortic arch screening.
• Aortic plaque materials were sampled and analyzed; Transesophageal echocardiography (TEE) was performed.

Main Results:

• NOGA identified seven SRAPs in six patients (24%) diagnosed with aortogenic stroke.
• Causes included aortic arch plaque, graft wall thrombus, and cholesterol crystals from plaque rupture.
• Other stroke causes identified were cardiogenic (16 patients) and cryptogenic (2 patients).

Conclusions:

• A systematic diagnostic protocol using NOGA enables proactive diagnosis of aortogenic stroke.
• NOGA and pathological analysis clarify the embolic source in ischemic stroke patients.
• The Brain-Heart team successfully diagnosed aortogenic stroke cases.