Abstract WP176: Assessing Genome-wide Associations With Ischemic Stroke Using Alternate Definitions of Stroke Subtypes: The SiGN Study

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sara Pulit ◽  
Hakan Ay ◽  
Robert D Brown ◽  
Dale M Gamble ◽  
Steven J Kittner ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Sample Size ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Classification Systems ◽  
Large Artery ◽  
Genetic Associations ◽  
Stroke Subtype ◽  
Stroke Subtypes ◽  
Small Artery Occlusion

Stroke subtype classification, applying standard criteria to clinical data, can reduce the heterogeneity of ischemic stroke for genetics studies. To date, most of the replicated genetic loci for ischemic stroke appear subtype-specific. Increasing homogeneity of phenotype comes with a trade-off in sample size, which influences the potential for successful identification of new loci. We estimated genetic associations using the union and intersection of two widely used stroke subtyping systems to assess the influence of sample size and homogeneity on test statistics. Methods: The Stroke Genetics Network (SiGN) study used both the Causative Classification of Stroke (CCS) and the Trial of ORG10172 Acute Stroke Trial (TOAST) classification systems. The CCS generates both a causal and a phenotypic subtype. Using all available data from case-control strata from the a previously performed GWAS, we focused on three main stroke subtypes: cardioembolic (CE), large artery atherosclerosis (LAA), and small artery occlusion (SAO). We estimated genetic associations with the union of the two CCS outputs and TOAST ( eg called CE by at least one method) and the intersection ( eg called CE by all three methods). Our modelling approach included a fixed-effects meta-analysis, i.e. pooling stratum specific estimates from logistic regression models using 10 principle components to account for genetic ancestry responsible for population stratification. Results: The majority of confirmatory findings from SiGN ( PITX2 and ZFHX3 for CE and HDAC9 for LAA) were evident in both models and in both the union and intersection of the subtyping systems. Some findings ( TSPAN2 in LAA) showed up best in the intersection with stronger corresponding p-values and odds ratios whereas other findings (12q24 for SAO) appear stronger in all of the union analyses, but were also evident in intersection analyses. We identify 16 potential novel loci, 6 of which appear in numerous analyses. Conclusion: Both expanding and refining stroke subtypes may help in the identification of additional stroke genetic risk variants and should be considered as complementary to a single classification system. We are pursuing replication of the novel findings.

Abstract 3884: Stroke Subtypes in Hispanic Patients in the NINDS Stroke Genetics Network (SiGN): A Comparison of Two Classification Systems

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Michael Katsnelson ◽  
Tatjana Rundek ◽  
Ralph Sacco ◽  
Hannah Gardener ◽  
Shaneela Malik ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Classification Systems ◽  
Blood Collection ◽  
Large Artery ◽  
Stroke Subtype ◽  
Reliable Determination ◽  
Stroke Treatment ◽  
Stroke Subtypes ◽  
Small Artery Occlusion

Objectives: Identification of gene variants of stroke subtypes is important for the development of tailored ischemic stroke therapies among various ethnic groups. Valid and reliable determination of ischemic stroke subtype is essential for achieving this goal and to standardize a classification scheme across multi-center studies and different populations. Causative Classification System for Ischemic Stroke (CCS) is a novel computerized subclassification tool developed to improve reliability and accuracy of classifying stroke types. The CCS algorithm relies on both phenotypic and causative stroke variables. A Hispanic subset of the SiGN, an important and distinct target population with greater risk of certain stroke subtypes, was evaluated with Trial of Org 10172 in Acute Stroke Treatment (TOAST) and CCS and the agreement between the two classification systems was analyzed. Methods: Over 6000 subjects at 15 sites across US and Europe were enrolled, with TOAST and CCS locally adjudicated. Blood collection and central data quality control (10% central readjudication) were performed on all participants. A subset of Hispanics was analyzed for the purpose of this study and the agreement between the TOAST and CCS were assessed by kappa statistic. Findings: Hispanics (n=595, 10.9%) compared to non-Hispanics (n=5457) were more likely to be younger (63.7 vs. 64.0), male (55% vs. 46%) and have fewer of the traditional stroke risk factors HTN (54% vs. 64%), Afib (11% vs. 14%), DM(23% vs. 25%), CAD(16% vs. 20%) and smoking(19% vs. 22%). While the TOAST showed no differences between stroke subtypes for Hispanic vs. non-Hispanics, in CCS, Hispanics were classified with more of large vessel (22% vs. 20%), cardioembolic (37% vs. 30%) and small vessel strokes (13% vs. 9%) and fewer with undetermined etiology (28% vs. 40%) as compared to non-Hispanics. TOAST and CCS offered moderate correlation across all stroke types in Hispanics: kappa of 0.66 for large artery atherosclerosis, 0.58 for cardioembolic, and 0.58 for small artery occlusion. Conclusion: CCS offers a more sensitive and accurate system for subphenotyping of strokes in Hispanics who tended to have relatively fewer risk factors and unclassified strokes. Further studies correlating the two classification systems and their relation to genotyping data are warranted.

Abstract T P153: Women and Men with Ischemic Stroke in SiGN Have Different Subtype Distributions and Risk Factors

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Kathryn M Rexrode ◽  
Braxton D Mitchell ◽  
Kathleen A Ryan ◽  
Steven J Kittner ◽  
Hakan Ay ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Stroke Risk ◽  
Cardioembolic Stroke ◽  
Relative Distribution ◽  
Large Artery ◽  
Stroke Risk Factors ◽  
Stroke Subtypes ◽  
Small Artery Occlusion ◽  
Ischemic Stroke Risk

Introduction: The relative distribution of stroke risk factors, as well as ischemic stroke subtypes, in women compared with men is not well described. Hypothesis: We hypothesized that the distribution of ischemic stroke risk factors and subtypes would differ by sex, with a later onset in women and greater proportion of comorbidities. Methods: The NINDS Stroke Genetics Network (SiGN) consortium was established to evaluate genetic risk factors for ischemic stroke. A total of 23 separate studies performed Causative Classification of Stroke (CCS) typing using standardized criteria on ischemic stroke cases and contributed data on risk factors. We compared the distribution of ischemic stroke risk factors and CCS phenotypes between men and women with ischemic stroke. Results: Of the 16,228 ischemic strokes in SiGN, 8005 (49.3%) occurred in women. Median age at stroke was older in female than male stroke cases (73 vs. 66 years) (p=<0.0001). Among stroke cases, women were more likely than men cases to have hypertension or atrial fibrillation and less likely to have diabetes or coronary artery disease, or to smoke (p <0.003 for all). The distribution of stroke subtypes also differed by sex, with women less likely than men to have large artery infarction and small artery occlusion, and more likely to have cardioembolic stroke and undetermined stroke due to incomplete work-up (p values all <0.0001; see Table). Results were similar when the distribution of stroke subtypes was examined for those <70 years and ≥70 years, except for cardioembolic stroke remaining more common only among women ≥70. Conclusions: In this large group of carefully phenotyped ischemic strokes, the distribution of ischemic stroke subtypes and risk factor profiles differ significantly by sex. Evaluation of the causes of these differences may highlight areas for improved prevention and risk reduction in both genders.

scholarly journals Detailed phenotyping of posterior vs. anterior circulation ischemic stroke: a multi-center MRI study

2019 ◽  
Vol 267 (3) ◽  
pp. 649-658 ◽  
Author(s):  
Petrea Frid ◽  
◽  
Mattias Drake ◽  
A. K. Giese ◽  
J. Wasselius ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Artery Occlusion ◽  
Large Artery ◽  
Small Artery ◽  
Anterior Circulation ◽  
Lesion Location ◽  
Stroke Subtypes ◽  
Small Artery Occlusion ◽  
Male Sex

Abstract Objective Posterior circulation ischemic stroke (PCiS) constitutes 20–30% of ischemic stroke cases. Detailed information about differences between PCiS and anterior circulation ischemic stroke (ACiS) remains scarce. Such information might guide clinical decision making and prevention strategies. We studied risk factors and ischemic stroke subtypes in PCiS vs. ACiS and lesion location on magnetic resonance imaging (MRI) in PCiS. Methods Out of 3,301 MRIs from 12 sites in the National Institute of Neurological Disorders and Stroke (NINDS) Stroke Genetics Network (SiGN), we included 2,381 cases with acute DWI lesions. The definition of ACiS or PCiS was based on lesion location. We compared the groups using Chi-squared and logistic regression. Results PCiS occurred in 718 (30%) patients and ACiS in 1663 (70%). Diabetes and male sex were more common in PCiS vs. ACiS (diabetes 27% vs. 23%, p < 0.05; male sex 68% vs. 58%, p < 0.001). Both were independently associated with PCiS (diabetes, OR = 1.29; 95% CI 1.04–1.61; male sex, OR = 1.46; 95% CI 1.21–1.78). ACiS more commonly had large artery atherosclerosis (25% vs. 20%, p < 0.01) and cardioembolic mechanisms (17% vs. 11%, p < 0.001) compared to PCiS. Small artery occlusion was more common in PCiS vs. ACiS (20% vs. 14%, p < 0.001). Small artery occlusion accounted for 47% of solitary brainstem infarctions. Conclusion Ischemic stroke subtypes differ between the two phenotypes. Diabetes and male sex have a stronger association with PCiS than ACiS. Definitive MRI-based PCiS diagnosis aids etiological investigation and contributes additional insights into specific risk factors and mechanisms of injury in PCiS.

scholarly journals Effect of Intensive Versus Standard Blood Pressure Control on Stroke Subtypes

Hypertension ◽  
2021 ◽  
Vol 77 (4) ◽  
pp. 1391-1398
Author(s):  
Clinton B. Wright ◽  
Alexander P. Auchus ◽  
Alan Lerner ◽  
Walter T. Ambrosius ◽  
Hakan Ay ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Blood Pressure Control ◽  
Standard Treatment ◽  
Pressure Control ◽  
Intensive Treatment ◽  
Large Artery ◽  
Stroke Subtypes ◽  
Small Artery Occlusion ◽  
Blood Pressures

In the SPRINT (Systolic Blood Pressure Intervention Trial), the number of strokes did not differ significantly by treatment group. However, stroke subtypes have heterogeneous causes that could respond differently to intensive blood pressure control. SPRINT participants (N=9361) were randomized to target systolic blood pressures of <120 mm Hg (intensive treatment) compared with <140 mm Hg (standard treatment). We compared incident hemorrhage, cardiac embolism, large- and small-vessel infarctions across treatment arms. Participants randomized to the intensive arm had mean systolic blood pressures of 121.4 mm Hg in the intensive arm (N=4678) and 136.2 mm Hg in the standard arm (N=4683) at one year. Sixty-nine strokes occurred in the intensive arm and 78 in the standard arm when SPRINT was stopped. The breakdown of stroke subtypes across treatment arms included hemorrhagic (intensive treatment, n=6, standard treatment, n=7) and ischemic stroke subtypes (large artery atherosclerosis: intensive treatment n=11, standard treatment, n=13; cardiac embolism: intensive treatment n=11, standard treatment n=15; small artery occlusion: intensive treatment n=8, standard treatment n=8; other ischemic stroke: intensive treatment n=3, standard treatment n=1). Fewer strokes occurred among participants without prior cardiovascular disease in the intensive (n=43) than the standard arm (n=61), but the difference did not reach predefined statistical significance level of 0.05 ( P =0.09). The interaction between baseline cardiovascular risk factor status and treatment arm on stroke risk did not reach significance ( P =0.05). Similar numbers of stroke subtypes occurred in the intensive BP control and standard control arms of SPRINT.

Abstract P491: Serum Fatty Acids Concentrations and Compositions, Lipids Concentrations and Their Correlation in Acute Ischemic Stroke Patients Aged 50 Years or Older

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Takahisa Mori ◽  
Kazuhiro Yoshioka
Keyword(s):  
Fatty Acids ◽  
Ischemic Stroke ◽  
Elderly Patients ◽  
Acute Ischemic Stroke ◽  
Negative Correlation ◽  
Large Artery ◽  
Stroke Subtype ◽  
Positive Correlation ◽  
Stroke Subtypes ◽  
Serum Fatty Acids

Background: Compositions of serum fatty acids (s-FAs), such as palmitic acid (PA), oleic acid (OlA), linoleic acid (LiA) and docosahexaenoic acid (DHA), and their correlation with serum lipids (s-LPs), such as total cholesterol (T-CHO) and triglycerides (TG), have been reported in healthy young or middle subjects. However, little is known about s-FAs features in acute ischemic stroke (AIS) patients. Hypothesis: Serum FAs features in AIS elderly patients are different from those in healthy young subjects and concentrations of s-FAs provide different correlation with s-LPs from compositions. Methods: We conducted a cross-sectional study of patients aged 50 years or older who were admitted to our institution between August 2016 and July 2019 within 24 hours of first AIS onset. We evaluated concentrations and compositions of s-FAs and their association with s-LPs, age and ischemic stroke subtype. Results: Three hundred sixty-six patients met our inclusive criteria. Their average age was 74.7 years, median T-CHO and TG were 203.5 and 102 mg/dl, respectively and median concentrations of PA, OlA, LiA and DHA were 642.5, 566.0, 723.0 and 129.8 μg/ml, respectively, and their median or mean compositions were 23.6, 20.9, 26.5 and 4.7 %, respectively. Concentrations of s-FAs had positive correlation with s-LPs. Concentrations of s-LPs and most of s-FAs had negative correlation with age. In stroke subtype of large-artery atherosclerosis or small-vessel occlusion (LAA_SVO) and in stroke subtype of cardioembolism or others (CE_O), mean age was 72.6 and 76.4 years (p<0.001), median TCHO was 214 and 194 mg/dl (p<0.0001), median TG was 113 and 95 mg/dl (p<0.05), median PA was 678.8 and 611.2 μg/ml (p<0.0001), median OlA was 613.8 and 532.4 μg/ml (p<0.001), median LiA was 767.2 and 696.1 μg/ml (p<0.001), and mean DHA was 131.4 and 127.9 μg/ml (ns). Compositions of PA, OlA, LiA and DHA had no correlation with T-CHO and compositions of PA and OlA had positive correlation with TG, whereas compositions of LiA and DHA had negative correlation with TG. Compositions of OlA had negative correlation with age, whereas DHA composition had positive correlation with age. There was little difference of compositions between stroke subtypes. Conclusions: In first AIS elderly patients, concentrations of most of s-FAs had positive correlation with s-LPs. In LAA_SVO, patients were younger and their concentrations of s-LPs and most of s-FAs were larger than in CE_O. On the other hand, correlation of s-FAs compositions with s-LPs was not constant and there was little difference of compositions between ischemic stroke subtypes.

scholarly journals White matter hyperintensity burden in acute stroke patients differs by ischemic stroke subtype

Neurology ◽  
2020 ◽  
Vol 95 (1) ◽  
pp. e79-e88 ◽  
Author(s):  
Anne-Katrin Giese ◽  
Markus D. Schirmer ◽  
Adrian V. Dalca ◽  
Ramesh Sridharan ◽  
Kathleen L. Donahue ◽  
...  
Keyword(s):  
Risk Factor ◽  
Ischemic Stroke ◽  
White Matter ◽  
Brain Mri ◽  
Vascular Risk Factor ◽  
White Matter Hyperintensity ◽  
Large Artery ◽  
Vascular Risk ◽  
Stroke Subtypes ◽  
Small Artery Occlusion

ObjectiveTo examine etiologic stroke subtypes and vascular risk factor profiles and their association with white matter hyperintensity (WMH) burden in patients hospitalized for acute ischemic stroke (AIS).MethodsFor the MRI Genetics Interface Exploration (MRI-GENIE) study, we systematically assembled brain imaging and phenotypic data for 3,301 patients with AIS. All cases underwent standardized web tool–based stroke subtyping with the Causative Classification of Ischemic Stroke (CCS). WMH volume (WMHv) was measured on T2 brain MRI scans of 2,529 patients with a fully automated deep-learning trained algorithm. Univariable and multivariable linear mixed-effects modeling was carried out to investigate the relationship of vascular risk factors with WMHv and CCS subtypes.ResultsPatients with AIS with large artery atherosclerosis, major cardioembolic stroke, small artery occlusion (SAO), other, and undetermined causes of AIS differed significantly in their vascular risk factor profile (all p < 0.001). Median WMHv in all patients with AIS was 5.86 cm3 (interquartile range 2.18–14.61 cm3) and differed significantly across CCS subtypes (p < 0.0001). In multivariable analysis, age, hypertension, prior stroke, smoking (all p < 0.001), and diabetes mellitus (p = 0.041) were independent predictors of WMHv. When adjusted for confounders, patients with SAO had significantly higher WMHv compared to those with all other stroke subtypes (p < 0.001).ConclusionIn this international multicenter, hospital-based cohort of patients with AIS, we demonstrate that vascular risk factor profiles and extent of WMH burden differ by CCS subtype, with the highest lesion burden detected in patients with SAO. These findings further support the small vessel hypothesis of WMH lesions detected on brain MRI of patients with ischemic stroke.

Abstract WP394: The Proteasome Subunit α Type 6 Rs1048990 Contributes To The Risk Of Ischemic Stroke And Its Subtypes: New Data And Meta-analysis

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Lihua Yu ◽  
Jingjing Zhang ◽  
Jian Guo ◽  
Jinghuan Fang ◽  
Ning Chen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Chinese Population ◽  
Meta Analysis ◽  
Significant Risk ◽  
Large Artery ◽  
Stroke Subtype ◽  
Vessel Occlusion ◽  
Proteasome Subunit ◽  
Expression Of Genes ◽  
Significant Difference

Background and purpose: The proteasome subunit α type 6 (PSMA6) is an important proteolytic protein regulating the expression of genes involved in inflammation. Recently, a functional polymorphism rs1048990, located in PSMA6 , has been reported with the susceptibility to ischemic stroke (IS) in several ethnic cohorts, but the results were inconsistent. Moreover, it still lacks the data in Asian. The purpose of the present study was to determine whether this polymorphism confers significant risk to IS in a Chinese population. Methods: A total of 1102 IS cases and 975 healthy controls were analyzed in our study. We genotyped rs1048990 with ligation detection reaction (LDR) method and then performed a meta-analysis. Results: Significant association between rs1048990 in PSMA6 and ischemic stroke was observed in all comparison models (genotype, p =0.016; allele, p =0.004; CG+GG vs. CC, adjusted p =0.006; GG vs. CG+CC, adjusted p =0.038). Further stratification for stroke subtype, similar differences also can be found in large artery atherosclerosis and cardioembolism, but not small vessel occlusion. In addition, in the analysis of genotype-phenotype correlation, the onset ages of allele-G carriers have a trend to be older than non-carriers’ ( p <0.001). In the meta-analysis, there is no significant difference between rs1048990 and ischemic stroke, for the great discrepancy of the genotype composition between Caucasian and Chinese. Conclusion: Our study suggests that rs1048990 contributes to the risk of IS and its subtypes in Chinese population, but these associations may vary in different ethnic populations.

Trimethylamine N-Oxide and Stroke Recurrence Depends on Ischemic Stroke Subtypes

Stroke ◽  
2021 ◽  
Author(s):  
Jie Xu ◽  
Aichun Cheng ◽  
Bo Song ◽  
Mingming Zhao ◽  
Jing Xue ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cox Regression ◽  
Meta Analysis ◽  
Artery Occlusion ◽  
Hazard Ratio ◽  
Stroke Recurrence ◽  
Large Artery ◽  
Small Artery ◽  
Increased Risk ◽  
Small Artery Occlusion

Background and Purpose: Trimethylamine N-oxide (TMAO) has been recognized as a risk factor for cardiovascular disease. However, the role of TMAO in ischemic stroke remains unclear. As we know, ischemic stroke is a heterogeneous disease with variable pathogenesis. Hence, we aimed to investigate the association between TMAO and stroke recurrence according to etiology subtypes. Methods: A total of 10 756 ischemic stroke/transient ischemic attack patients from the Third China National Stroke Registry were enrolled, and 1-year follow-up data for stroke recurrence were analyzed. TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria was used to classify the etiology subtypes. Plasma TMAO levels were quantified by liquid chromatography–mass spectrometry. The association between TMAO and stroke outcomes was analyzed using Cox regression models. We also conducted a meta-analysis on the association of TMAO levels and stroke risk. Results: Elevated TMAO level was independently associated with the risk of stroke recurrence (Q4 versus Q1: adjusted hazard ratio, 1.37 [95% CI, 1.15–1.64]) in multivariate Cox regression model. After stratification by TOAST subtypes, there was a significant association between TMAO and stroke recurrence in small artery occlusion subtype (adjusted hazard ratio, 1.43 [95% CI, 1.03–2.00]) but not in the others subtype (large-artery atherosclerosis, 1.19 [0.95–1.48]; cardioembolism, 1.54 [0.95–2.48]; others, 1.19 [0.98–1.44]). The meta-analysis reported on stroke recurrence for the highest versus lowest TMAO levels with a pooled hazard ratio of 1.66 (95% CI, 0.91–3.01) and similarly found an increased risk of stroke recurrence. Conclusions: Elevated TMAO level is associated with increased risk of stroke recurrence in patients with small artery occlusion subtype, but this association seems to be attenuated in large-artery atherosclerosis, cardioembolism, and others subtypes.

Abstract TP227: Vascular Calcification, Atherosclerosis Burden, and Stroke Mechanism in Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Takashi Shimoyama ◽  
Kunio Nakamura ◽  
Sibaji Gaj ◽  
Shivakrishna Kovi ◽  
Ken Uchino
Keyword(s):  
Ischemic Stroke ◽  
Large Artery ◽  
Stroke Patients ◽  
Stroke Subtype ◽  
Vessel Occlusion ◽  
Stroke Registry ◽  
Stroke Subtypes ◽  
Toast Classification ◽  
Stroke Mechanism ◽  
Post Hoc

Background and Purpose: Calcification of the intracranial carotid artery is recognized as a risk factor for stroke in the general population. The significance of vascular calcifications in its relationship stroke mechanisms is incompletely understood. We hypothesized that vascular calcium quantification using CT angiography (CTA) can differ by stroke mechanism among ischemic stroke patients. Methods: From a prospective single-hospital stroke registry from 2018, we identified ischemic stroke patients who underwent CTA. Automatic artery and calcification segmentation method measured calcification volumes in the intracranial, extracranial, and aortic arteries using deep-learning U-net model and region-grow algorithms. Stroke subtypes were diagnosed based on the TOAST classification: large artery atherosclerosis (LAA), small vessel occlusion (SVO), cardioembolism (CE), others/undetermined. We evaluated the relationship between CTA calcification volume and stroke subtypes on one-way ANOVA and Tukey’s post-hoc test. Results: Of the 558 consecutive acute ischemic stroke patients, we enrolled 388 patients (212 males; mean age 66.6 years) in the study. Others/undetermined (34.8%) was the most frequent stroke subtype, followed by CE (29.4%), LAA (25.5%), and SVO (10.3%). The overall prevalence of atherosclerotic calcification was 95.9% in stroke patients. LAA had significantly higher calcification volume with 809 mm 3 compared to SVO (390 mm 3 , P=0.040), others/undetermined (300 mm 3 , P=0.001), but not CE (860 mm 3 , P=0.958). In age < 65 years subset, LAA showed higher calcification volume with 567 mm 3 than SVO (176 mm 3 , P=0.014), CE (213 mm 3 , P=0.021) and others/undetermined (180 mm 3 , P<0.001). There were no significant differences in calcification volume among stroke subtypes in age ≥65 years. Conclusion: Atherosclerotic calcium burden with a quantitative analysis of CTA images may be useful to differentiate stroke mechanism in younger patients.

Abstract WP128: Stroke Subtype Predicts Neurological Deterioration After Intravenous Alteplase for Acute Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Alexander Allen ◽  
Katarina Dakay ◽  
Brittany Ricci ◽  
Andrew Chang ◽  
Brian Mac Grory ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Intracranial Hemorrhage ◽  
Small Vessel Disease ◽  
Small Vessel ◽  
Large Artery ◽  
Stroke Subtype ◽  
Vessel Disease ◽  
Stroke Subtypes ◽  
Intravenous Alteplase

Introduction: Intravenous alteplase improves functional outcome in patients with acute ischemic stroke. While patients often have better outcomes, other patients may experience recurrent or worsening symptoms. We sought to determine the association between stroke subtype and neurologic deterioration in this study cohort. Methods: Data were abstracted from a prospective quality improvement registry at a comprehensive stroke center. Patients with symptomatic intracranial hemorrhage, no follow-up imaging, code status change to comfort measures only in the first 24 hours, or stroke mimics were excluded. Recurrent cerebrovascular events (RCVE) were defined as any new or worsening symptoms due to cerebral ischemia in the absence of intracranial hemorrhage or an alternative etiology such as infection or seizure. We compared demographic factors, vascular comorbidities, admission blood pressure, medications, use and timing of antithrombotics during hospitalization, admission NIH stroke scale, endovascular intervention, stroke subtype [Cardioembolic, large artery atherosclerosis, small vessel disease, cryptogenic, and other defined (such as dissection, hypercoagulability, cancer related, illicit drug use)], and good 90-day outcome (mRS 0-1) between the two groups using Fisher’s exact test and t-test as indicated. We then performed multivariable logistic regression analyses to determine associations between stroke subtypes and RCVE. Results: We identified 705 patients treated with tPA, and 606 met the inclusion criteria. The rate of RCVE was 5.8% (35/606). In multivariable analyses, when compared to cardioembolic/cryptogenic stroke, RCVE was more common in small vessel disease (adjusted OR 9.51 p=0.029), large vessel disease (adjusted OR 5.60, p=0.033), and other stroke mechanisms (adjusted OR 11.29, p=0.019). RCVE was associated with more disability at 90 days when compared to non-RCVE (median mRS 4, IQR 3 vs. median mRS 3, IQR 2, p = 0.016). Conclusions: Non-cryptogenic/Non-cardioembolic stroke subtypes are associated with early RCVE, and RCVE is associated with long term disability. Studies are needed to confirm our findings and test interventions optimizing stroke prevention strategies in these subtypes.

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