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Impact on etiology diagnosis by high-resolution vessel wall imaging in young adults with ischemic stroke or transient ischemic attack

  • Diagnostic Neuroradiology
  • Published:
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Abstract

Purpose

The etiological features of stroke in young adults are different from those in older adults. We aimed to investigate the impact of high-resolution vessel wall imaging (HRVWI) on etiologic diagnosis in young adults with ischemic stroke or transient ischemic attack (TIA).

Methods

A total of 253 young adults (aged 18–45 years) who consecutively underwent HRVWI for clarifying stroke etiology were retrospectively recruited. Two experienced neurologists classified stroke etiology for each patient using Trial of Org 10,172 in Acute Stroke Treatment categories with and without the inclusion of HRVWI diagnosis. Multivariate logistic regression was performed to determine which etiologic category would be significantly impacted after including HRVWI.

Results

The etiologic classification was altered in 39.1% (99/253) of patients after including HRVWI in the conventional investigations. The proportion of patients classified as having stroke of undetermined etiology (SUE) and the proportion of patients classified as having small-artery occlusion (SAO) both significantly decreased (36.4 to 13.8% and 9.1 to 2.0%), whereas the proportion of patients classified as having large artery atherosclerosis (LAA) significantly increased (28.5 to 58.1%) (all P < 0.001). The inclusion of HRVWI had a significant diagnostic impact on young adults who were primarily classified as SAO (odds ratio [OR] 14.4, 95% confidence interval [CI] [2.9, 71.8], P < 0.001) or SUE (OR 8.3, 95% CI [2.2, 31.5], P < 0.01).

Conclusions

HRVWI had a substantial impact on etiologic classification in young adults with ischemic stroke or TIA, particularly for those primarily classified as having SAO or SUE. This impact of HRVWI will be beneficial for therapeutic decision-making.

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Data availability

Data are available upon reasonable request.

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Acknowledgements

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Funding

This work was supported by the National Natural Science Foundation of China (grant number: 82171907 to Shan-shan Lu).

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Author notes

  1. Wen-wen He and Shan-shan Lu contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China

    Wen-wen He, Shan-shan Lu, Zi-zhen Shen & Fei-yun Wu

  2. Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China

    Song Ge & Ping Gu

  3. Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Gulou District, Nanjing, Jiangsu Province, China

    Hai-bin Shi

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  1. Wen-wen He
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Contributions

Conceptualization: SSL, HBS. Data curation: WWH, SSL, ZZS, SG, PG, FYW. Formal analysis: WWH, SSL, SG, PG, HBS, and FYW. Funding acquisition: SSL. Investigation: SSL, HBS. Methodology: SSL, PG, HBS. Project administration: HBS, SSL, FYW, PG. Supervision and validation: FYW, HBS, PG. Writing–original draft: WWH, SSL, writing—review and editing: FYW, HBS.

Corresponding author

Correspondence to Hai-bin Shi.

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Competing interests

All the authors declare that they have no competing interests.

Ethics approval

The study protocol was approved by Jiangsu province hospital Ethics Board.

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The need for patient consent of this study was waived by Jiangsu province hospital Ethics Board due to its retrospective nature.

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He, Ww., Lu, Ss., Ge, S. et al. Impact on etiology diagnosis by high-resolution vessel wall imaging in young adults with ischemic stroke or transient ischemic attack. Neuroradiology 65, 1015–1023 (2023). https://doi.org/10.1007/s00234-023-03131-y

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