Work

Diagnostic Impact of Intracranial Vessel Wall MRI on Ischemic Stroke Etiology in Young Adults

Year: 2026

Type: article

Abstract: BACKGROUND: Intracranial vessel wall imaging (VWI) enables visualization of arterial wall pathology and may improve etiologic classification of ischemic stroke, but existing evidence is largely based on retrospective studies. We aimed to prospectively evaluate the diagnostic impact of VWI in young stroke patients. METHODS: In this two-centre study, consecutive patients aged 18-59 years with acute ischemic stroke in the middle cerebral or anterior choroidal artery territory underwent contrast-enhanced VWI within 2 weeks of stroke onset. Stroke etiology was assessed using the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) and the Causative Classification of Stroke (CCS) classifications before and after incorporating VWI findings. Changes in etiologic classification and predictors of diagnostic change were analyzed. RESULTS: Sixty-nine patients were included (median age 53 years, 72% male). Incorporation of VWI findings resulted in a change in etiologic classification in 9/69 (13%) patients according to TOAST and 10/69 (14%) according to CCS. For TOAST classification, the proportion of large artery atherosclerosis increased from 17% to 28%, while cryptogenic stroke decreased from 22% to 14%. Baseline cryptogenic stroke was associated with etiologic reclassification after adjustment for age and sex (OR 7.8, 95% CI: 1.2-49.7; p = 0.029). CONCLUSIONS: VWI frequently identified intracranial atherosclerotic plaques not evident on luminal imaging, leading to etiologic reclassification predominantly toward large artery atherosclerosis. These findings suggest incremental diagnostic value in the etiologic assessment of young stroke, particularly in cryptogenic cases. Larger prospective studies are warranted to determine its role in routine diagnostic algorithms.

Source: European Journal of Neurology

DOI: 10.1111/ene.70795