Propensity Score-Matched Analysis of Lesion Patterns in Stroke Patients With Patent Foramen Ovale and Patients With Spontaneous Intracranial Artery Dissection.

Yangyang Huang,Yong Bi,Jianhua Zhuang,Bei Shao,Huazheng Liang,Xuanyou Zhou,Yifan Cheng

doi:10.3389/fneur.2019.00418

Abstract

Aims: To investigate the relationship between clinical and imaging features of stroke patients with patent foramen ovale (PFO) and those with spontaneous intracranial artery dissection (SIAD).Materials and methods: We retrospectively examined both clinical and imaging results of 40 stroke patients with PFO and 29 with SIAD. To reduce selection bias, we conducted a propensity score-matching analysis. The patients' propensity scores were estimated using a logistic regression model based on the following variables: age, sex, hypertension, diabetes mellitus, hypercholesterolemia, cigarette smoking, stroke histories, and their NIHSS scores. We compared the pattern of cerebral DWI lesions between patients with PFO and those with SIAD.Results: After propensity score matching, 21 pairs of patients were selected. Clinical characteristics of the 2 groups were well matched. The distribution of DWI lesion patterns differed between the 2 groups. Single lesions (cortical or subcortical) were more frequently observed in the PFO group than in the SIAD group (P = 0.026). Multiple lesions in one vascular territory occurred more frequently in the SIAD group than in the PFO group (P = 0.035).Conclusion: The present study suggests that lesion patterns observed from DWI of patients with PFO and SIAD might provide clues to the etiology of infarcts. Single lesions (cortical or subcortical) might be a typical feature of PFO associated strokes, while multiple lesions in one vascular territory might be a specific feature of SIAD associated strokes.

Highlights

Both patent foramen ovale (PFO) and spontaneous intracranial artery dissection (SIAD) are important stroke risk factors, especially in young and middle-aged adults [1,2,3]
Artery-to-artery embolism and reduced blood flow due to the primary lesion are the two basic mechanisms with which spontaneous cervical artery dissection led to strokes [9, 10], whereas artery-to-artery embolism is considered to be the primary mechanism with which spontaneous vertebral artery dissection led to strokes [11, 12]
Inclusion criteria for stroke patients due to SIAD were: [1] definite angiographic findings of dissection in intracranial arteries; [2] presence of ischemic stroke lesions on Diffusionweighted imaging (DWI); [3] according to the TOAST criteria, no definite causes had been identified apart from dissection after a standardized workup; [4] PFO was excluded by transesophageal echocardiography (TEE) and transcranial Doppler (TCD); [5]

Summary

Introduction

Both patent foramen ovale (PFO) and spontaneous intracranial artery dissection (SIAD) are important stroke risk factors, especially in young and middle-aged adults [1,2,3]. A prior study has assessed brain Magnetic resonance imaging (MRI) features of stroke patients due to PFO and SIAD and found that, a single non-territorial infarct seemed to favor strokes due to PFO, whereas territorial infarcts (with or without additional smaller lesions in the same territory) were more likely to occur in patients with arterial dissection [6]. This study did not individually compare between patients with carotid dissection, vertebral dissection, and those with PFO, respectively, though the former two types of patients had different mechanisms of stroke pathogenesis. In SIAD, spontaneous cervical artery dissection showed different clinical and imaging features from spontaneous vertebral artery dissection [7, 8]. The other thing to note is that the baseline data of some studies are not consistent with each other, which leads to systemic bias in data analysis and subsequently the findings from these studies are not trustworthy

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Results

Conclusion