Atherosclerosis as a Potential Cause of Deep Embolic Stroke of Undetermined Source: A 3T High‐Resolution Magnetic Resonance Imaging Study

Figures

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  Figure 1. Flow diagram of the study. AAA indicates aortic arch atherosclerosis; and ESUS, embolic stroke of undetermined source.

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  Figure 2. Illustration showing an example of deep ESUS vs cortical with/without deep ESUS. A, Cortical with/without deep ESUS. From left to right: schematic diagram of complicated plaque opposite the ostia of the perforator, examples of diffusion weighted imaging and magnetic resonance angiography for cortical with/without deep ESUS, the plaque with IPH (A1–A3, thick arrows), the plaque with a larger PB (A4, thick arrow), and positive remodeling (A4, arrowhead). B, Deep ESUS. From left to right: schematic diagram of stable plaque at the ostia of the perforator, examples of diffusion weighted imaging and magnetic resonance angiography for deep ESUS, the plaque with smaller PB (B1–B3, thick arrows), the plaque with a thick FC (B4, arrowhead), a smaller LRNC (B4, thin arrow), and at the ostia of perforator (B4, thick arrow). ESUS indicates embolic stroke of undetermined source; FC, fibrous cap; IPH, intraplaque hemorrhage; LRNC, lipid‐rich necrotic core; and PB, plaque burden.

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  Figure 3. Schematic diagram of plaque burden (PB) and remodeling index (RI).

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  Figure 4. Subgroup analyses by stratification. Biomarkers of plaque vulnerability stratified by infarct patterns for predicting ESUS are shown. CP indicates complicated plaque; ESUS, embolic stroke of undetermined source; OR, odds ratio; PB, plaque burden; and RI, remodeling index.

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  Figure 5. Comparison of ROC analysis before and after excluding patients with deep ESUS. A, ROC curve analysis of vulnerability of NIAP for predicting ESUS before excluding patients with deep ESUS. B, ROC curve analysis of vulnerability of NIAP for predicting ESUS after excluding patients with deep ESUS. AUC indicates area under the curve; CP, complicated plaque; DPS, discontinuity of plaque surface; ESUS, embolic stroke of undetermined source; IPH, intraplaque hemorrhage; NIAP, nonstenotic intracranial atherosclerotic plaque; PB, plaque burden; RI, remodeling index; and ROC, receiver operating characteristic.