Patients With Undetermined Stroke Have Increased Atrial Fibrosis: A Cardiac Magnetic Resonance Imaging Study. Fonseca Ana Catarina,Alves Pedro,Inácio Nuno,Marto João Pedro,Viana-Baptista Miguel,Pinho-E-Melo Teresa,Ferro José M,Almeida Ana G Stroke BACKGROUND AND PURPOSE:Some patients with ischemic strokes that are currently classified as having an undetermined cause may have structural or functional changes of the left atrium (LA) and left atrial appendage, which increase their risk of thromboembolism. We compared the LA and left atrial appendage of patients with different ischemic stroke causes using cardiac magnetic resonance imaging. METHODS:We prospectively included a consecutive sample of ischemic stroke patients. Patients with structural changes on echocardiography currently considered as causal for stroke in the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification were excluded. A 3-T cardiac magnetic resonance imaging was performed. RESULTS:One hundred and eleven patients were evaluated. Patients with an undetermined cause had a higher percentage of LA fibrosis (=0.03) than patients with other stroke causes and lower, although not statistically significant, values of LA ejection fraction. Patients with atrial fibrillation and undetermined stroke cause showed a similar value of atrial fibrosis. CONCLUSIONS:The LA phenotype that was found in patients with undetermined cause supports the hypothesis that an atrial disease may be associated with stroke. 10.1161/STROKEAHA.117.019641

High-Resolution Magnetic Resonance Imaging of Cervicocranial Artery Dissection: Imaging Features Associated With Stroke. Wu Ye,Wu Fang,Liu Yuehong,Fan Zhaoyang,Fisher Marc,Li Debiao,Xu Weihai,Jiang Tao,Cheng Jingliang,Sun Bin,Ji Xunming,Yang Qi Stroke Background and Purpose- We aimed to systematically investigate the characteristics of cervicocranial artery dissection (CCAD) on high-resolution magnetic resonance imaging that are associated with acute ischemic stroke. Methods- Patients with CCAD were recruited and divided into stroke and nonstroke groups. The lesion location, the presence of a double lumen, intimal flap, intramural hematoma, pseudoaneurysm, irregular surface, intraluminal thrombus, and other quantitative parameters of each dissected segment were reviewed. Multiple logistic regression was used to examine the association between imaging features of CCAD and ischemic stroke. Results- A total of 145 affected vessels from 118 patients with CCAD were analyzed. Anterior circulation, intramural hematoma, irregular surface, intraluminal thrombus, and severe stenosis (>70%) on high-resolution magnetic resonance imaging were more prevalent in CCAD patient with stroke (54.4% versus 36.4%; =0.030, 96.2% versus 84.8%; =0.017, 74.7% versus 37.9%; <0.001, 44.3% versus 4.5%; <0.001, and 54.4% versus 31.8%; =0.008, respectively). In multivariable logistic regression analysis, the presence of irregular surface and intraluminal thrombus on imaging were independently associated with acute ischemic stroke in CCAD with odds ratios of 4.29 (95% CI, 1.61-11.46, =0.004) and 7.48 (95% CI, 1.64-34.07, =0.009). Conclusions- The current findings supported that the presence of irregular surface and intraluminal thrombus were related to stroke occurrence in patients with CCAD. High-resolution magnetic resonance imaging might give insights into pathogenesis of ischemic stroke in CCAD. It may be useful for individual prediction of ischemic stroke early in CCAD. 10.1161/STROKEAHA.119.026362