EXPRESS: Evolving Ischemic Stroke Subtypes in 15 years: A hospital-based observational study

Background: Depicting the time trends of ischemic stroke subtypes may inform healthcare resource allocation on etiology-based stroke prevention and treatment. Aim: To reveal the evolving ischemic stroke subtypes from 2004 to 2018. Methods: We determined the stroke etiology of consecutive first-ever transient ischemic attack or ischemic stroke patients admitted to a regional hospital in Hong Kong from 2004 to 2018. We analyzed the age-standardized incidences and the 2-year recurrence rate of major ischemic stroke subtypes. Results: Among 6940 patients admitted from 2004 to 2018, age-standardized incidence of ischemic stroke declined from 187.0 to 127.4 per 100,000 population (p<0.001), driven by the decrease in large artery disease (43.0 to 9.67 per 100,000 population (p<0.001)) and small vessel disease (71.9 to 45.7 per 100,000 population (p<0.001)). Age-standardized incidence of cardioembolic stroke did not change significantly (p=0.2). Proportion of cardioembolic stroke increased from 20.4% in 2004-2006 to 29.3% in 2016-2018 (p<0.001). 2-year recurrence rate of intracranial atherothrombotic stroke reduced from 19.3% to 5.1% (p<0.001) with increased prescriptions of statin (p<0.001) and dual anti-platelet therapy (<0.001). In parallel with increased anticoagulation use across the study period (p<0.001), the 2-year recurrence of AF-related stroke reduced from 18.9% to 6% (p<0.001). Conclusion: Etiology-based risk factor control might have led to the diminishing stroke incidences related to atherosclerosis. To tackle the surge of AF-related strokes, arrhythmia screening, anticoagulation usage and mechanical thrombectomy service should be reinforced. Comparable preventive strategies might alleviate the enormous stroke burden in mainland China.

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Patient Demographics, Characteristics, and Intrahospital Mortality of Different Ischemic Stroke Subtypes in a Tertiary Hospital during Five-Year Period

Medical Sciences Forum ◽

10.3390/iecmd2021-10315 ◽

2021 ◽

Vol 6 (1) ◽

pp. 6

Author(s):

Sintija Strautmane ◽

Kristaps Jurjāns ◽

Estere Zeltiņa ◽

Evija Miglāne ◽

Andrejs Millers

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Reperfusion Therapy ◽

Cardioembolic Stroke ◽

Study Group ◽

Large Artery ◽

Patient Demographics ◽

Stroke Subtypes ◽

Female Predominance ◽

Study Population

Background and Objectives. Ischemic stroke (IS) is one of the leading causes of disability, morbidity, and mortality worldwide. The goal of the study was to evaluate patient demographics, characteristics, and intrahospital mortality among different ischemic stroke subtypes. Materials and Methods. A retrospective observational non-randomized study was conducted, including only ischemic stroke patients, admitted to Pauls Stradins Clinical university hospital, Riga, Latvia, from January of 2016 until December 2020. Ischemic stroke subtypes were determined according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria as a stroke due to (1) large-artery atherosclerosis (atherothrombotic stroke (AS)), (2) cardioembolism (cardioembolic stroke (CS)), (3) small-vessel occlusion (lacunar stroke (LS)), (4) stroke of other determined etiology (other specified stroke (OSS)), and (5) stroke of undetermined etiology (undetermined stroke (US)). The data between different stroke subtypes were compared. Results. There was a slight female predominance among our study population, as 2673 (56.2%) patients were females. In our study group, the most common IS subtypes were cardioembolic stroke (CS), 2252 (47.4%), and atherothrombotic stroke (AS), 1304 (27.4%). CS patients were significantly more severely disabled on admission, 1828 (81.4%), and on discharge, 378 (16.8%), p < 0.05. Moreover, patients with CS demonstrated the highest rate of comorbidities and risk factors. This was also statistically significant, p < 0.05. Differences between the total patient count with no atrial fibrillation (AF), paroxysmal AF, permanent AF, and different IS subtypes among our study population demonstrated not only statistical significance but also a strong association, Cramer’s V = 0.53. The majority of patients in our study group were treated conservatively, 3389 (71.3%). Reperfusion therapy was significantly more often performed among CS patients, 770 (34.2%), p < 0.05. The overall intrahospital mortality among our study population was 570 (12.0%), with the highest intrahospital mortality rate noted among CS patients, 378 (66.3%), p < 0.05. No statistically significant difference was observed between acute myocardial infarction and adiposity, p > 0.05. Conclusions. In our study, CS and AS were the most common IS subtypes. CS patients were significantly older with slight female predominance. CS patients demonstrated the greatest disability, risk factors, comorbidities, reperfusion therapy, and intrahospital mortality.

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

Stroke ◽

10.1161/str.45.suppl_1.tp153 ◽

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.

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Abstract TP159: Correlation Between Arterial Stiffness And The Severity Of Acute Cerebral Infarction

Stroke ◽

10.1161/str.44.suppl_1.atp159 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

YEONG-BAE LEE ◽

Joo-Hwan Park ◽

Eunja Kim ◽

Ki-Tae Kim ◽

Ju Kang Lee ◽

...

Keyword(s):

Ischemic Stroke ◽

Arterial Stiffness ◽

Acute Ischemic Stroke ◽

Pulse Wave ◽

Small Vessel Disease ◽

Large Artery ◽

Significant Difference ◽

Initial Severity ◽

Artery Disease ◽

Toast Classification

Arterial stiffness is an independent predictor of cardiovascular disease and stroke and can be evaluated by measuring pulse wave velocity(PWV) between 2 sites in the arterial tree, with a higher PWV indicating stiffer arteries. Recent studies have demonstrated that arterial stiffness is associated with intracranial large artery disease and the severity of cerebral small vessel disease. The aim of this study is to clarify whether pulse wave velocity value predict initial severity of acute ischemic stroke. We enrolled consecutive patients with acute ischemic stroke. Demographic factors, laboratory data, brain imaging, neurological exam and arterial stiffness measured by brachial ankle PWV (baPWV) were evaluated on admission in all subjects. The subtype of acute ischemic stroke was classified according to the TOAST classification. All patients were categorized into two groups based on the initial severity of stroke, indicated by modified Rankin Scale(mRS). Severe group was defined as a mRS ≥ 3 at admission. Unpaired student’s t-test or Mann-whitney U-test were used to compare maximal and meanbaPWV values between two groups. We enrolled 78 patients. According to the TOAST classification, the etiology of stroke was large artery disease (LAD) in 34 patients, small vessel disease (SVD) in 23 patients, and other subtypes in 12 patients. There were 28 patients with good outcome and 41 patients with poor outcome. The maximal and mean baPWV values were significantly increased in inpatients with high mRS score (2120.17± 527.75, 1999.21 ± 437.46) compared with those with low mRS score (1751.96 ± 363.49, 1723.14 ± 353.02)(p=0.001, p=0.007). In patients with SVD subtype, there was significant difference in maximal and mean baPWVvalues between two groups (p=0.030, p=0.047), whereas there was no significant difference in baPWV in patients with LAD subtype (p=0.141, p=0.172). The main finding of our study is that arterial stiffness indicated by baPWV is associated with the initial severity of acute ischemic stroke. Because initial stroke severity is strongly associated with functional outcome of stroke, this findings suggest that measurement of baPWV may predict long-term outcome in patients with stroke especially in those with TOAST classification confirmed as SVD.

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Abstract W P146: Low Serum Level of Eicosapentanoic Acid (EPA) is Associated with Occurrence of Nonlobar Type Intracerebal Hemorrhage (ICH)

Stroke ◽

10.1161/str.45.suppl_1.wp146 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Yasuhisa Akaiwa ◽

Hiroki Takano ◽

Hiroyuki Arakawa ◽

Itaru Ninomiya ◽

Masahiro Uemura ◽

...

Keyword(s):

Blood Pressure ◽

Fatty Acids ◽

Ischemic Stroke ◽

Polyunsaturated Fatty Acids ◽

Small Vessel Disease ◽

Routine Practice ◽

Large Artery ◽

Omega 3 ◽

Stroke Patients ◽

Stroke Subtypes

Background: : Intake of omega-3 polyunsaturated fatty acids, such as EPA, has been reported to have protective effects on various diseases including ischemic stroke. However, there have been few studies concerning the effect of omega-3 polyunsaturated fatty acids on hemorrhagic stroke. We studied associations of serum levels of EPA with stroke subtypes including primary ICH Methods: We have examined serum EPA and arachidonic acid (AA) levels in routine practice since 2009. To calibrate the EPA values, we calculated EPA/AA ratio. A total of 212 consecutive acute stroke patients and 27 control subjects were included. The patients 40 years old or younger were excluded. Ischemic stroke subtypes were determined based on TOAST criteria. Primary ICH was classified into lobar or nonlobar types, according to the region of the brain in which it occurred. Results: Of all the 157 ischemic stroke patients (female 47, mean age 72.9 years), 62 were classified with cardioembolic stroke (CES), 25 large-artery atherosclerotic (LAA), 22 small-vessel disease (SVD), and 48 other/undetermined causes (O/U). Of all the 55 ICH patients (female 23, mean age 71.0), 34 patients had nonlobar type, and 21 had lobar one. There were no significant intergroup differences in the mean EPA/AA ratio (p=0.525) among CES (EPA/AA= 0.67±0.42), LAA (0.70±0.30), SVD (0.65±0.45), O/U (0.62±0.38), nonlobar ICH (0.51±0.30), lobar ICH (0.64±0.33), and control (0.60±0.42) groups. However, the EPA/AA ratio of the nonlobar ICH group was considerably low. The EPA/AA ratio of the nonlobar ICH group was significantly (p=0.033) lower than that of the whole other groups (0.65±0.39) and significantly (p=0.003) lower than that of the entire ischemic stroke groups (0.67±0.40). Although the significant differences between the nonlobar ICH and the whole ischemic groups were also observed in systolic and diastolic blood pressure (195±37/107±25 mmHg vs 159±35/82±19 mmHg, p<0.001), multiple linear regression analyses showed the association between the EPA/AA and nonlobar ICH was independent from the blood pressure. Conclusions: Although the strongest risk factor for nonlobar ICH is hypertension, low EPA/AA ratio might play a role in the development of nonlobar ICH.

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Genetically determined blood pressure, antihypertensive drug classes, and risk of stroke subtypes

Neurology ◽

10.1212/wnl.0000000000009814 ◽

2020 ◽

Vol 95 (4) ◽

pp. e353-e361 ◽

Cited By ~ 1

Author(s):

Marios K. Georgakis ◽

Dipender Gill ◽

Alastair J.S. Webb ◽

Evangelos Evangelou ◽

Paul Elliott ◽

...

Keyword(s):

Ischemic Stroke ◽

Calcium Channel ◽

Antihypertensive Drug ◽

Small Vessel Disease ◽

Small Vessel ◽

Channel Blockers ◽

Large Artery ◽

Stroke Subtypes ◽

Drug Classes ◽

Genetically Determined

ObjectiveWe employed Mendelian randomization to explore whether the effects of blood pressure (BP) and BP-lowering through different antihypertensive drug classes on stroke risk vary by stroke etiology.MethodsWe selected genetic variants associated with systolic and diastolic BP and BP-lowering variants in genes encoding antihypertensive drug targets from genome-wide association studies (GWAS) on 757,601 individuals. Applying 2-sample Mendelian randomization, we examined associations with any stroke (67,162 cases; 454,450 controls), ischemic stroke and its subtypes (large artery, cardioembolic, small vessel stroke), intracerebral hemorrhage (ICH, deep and lobar), and the related small vessel disease phenotype of white matter hyperintensities (WMH).ResultsGenetic predisposition to higher systolic and diastolic BP was associated with higher risk of any stroke, ischemic stroke, and ICH. We found associations between genetically determined BP and all ischemic stroke subtypes with a higher risk of large artery and small vessel stroke compared to cardioembolic stroke, as well as associations with deep, but not lobar ICH. Genetic proxies for calcium channel blockers, but not β-blockers, were associated with lower risk of any stroke and ischemic stroke. Proxies for calcium channel blockers showed particularly strong associations with small vessel stroke and the related radiologic phenotype of WMH.ConclusionsThis study supports a causal role of hypertension in all major stroke subtypes except lobar ICH. We find differences in the effects of BP and BP-lowering through antihypertensive drug classes between stroke subtypes and identify calcium channel blockade as a promising strategy for preventing manifestations of cerebral small vessel disease.

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Incidence, recurrence, and long-term survival of ischemic stroke subtypes: A population-based study in the Middle East

International Journal of Stroke ◽

10.1177/1747493016684843 ◽

2017 ◽

Vol 12 (8) ◽

pp. 835-843 ◽

Cited By ~ 15

Author(s):

Hamidreza Saber ◽

Amanda G Thrift ◽

Moira K Kapral ◽

Ashkan Shoamanesh ◽

Amin Amiri ◽

...

Keyword(s):

Ischemic Stroke ◽

Middle East ◽

Incidence Study ◽

Incidence Rates ◽

Large Artery ◽

Small Artery ◽

Community Based ◽

Stroke Incidence ◽

Stroke Subtypes ◽

Artery Disease

Background Incidence, risk factors, case fatality and survival rates of ischemic stroke subtypes are unknown in the Middle East due to the lack of community-based incidence stroke studies in this region. Aim To characterize ischemic stroke subtypes in a Middle Eastern population. Methods The Mashad Stroke Incidence Study is a community-based study that prospectively ascertained all cases of stroke among the 450,229 inhabitants of Mashhad, Iran between 2006 and 2007. We identified 512 cases of first-ever ischemic stroke [264 men (mean age 65.5 ± 14.4) and 248 women (mean age 64.14 ± 14.5)]. Subtypes of ischemic stroke were classified according to the TOAST criteria. Incidence rates were age standardized to the WHO and European populations. Results The proportion of stroke subtypes was distributed as follows: 14.1% large artery disease, 15% cardioembolic, 22.5% small artery disease, 43.9% undetermined and 4.5% other. The greatest overall incidence rates were attributed to undetermined infarction (49.97/100,000) followed by small artery disease (25.54/100,000). Prevalence of hypertension, diabetes and atrial fibrillation differed among ischemic stroke subtypes. Overall, there were 268 (52.34%) deaths and 73 (14.25%) recurrent strokes at five years after incident ischemic stroke, with the greatest risk of recurrence seen in the large artery disease (35.6%) and cardioembolic (35.5%) subgroups. Survival was similar in men and women for each stroke subtype. Conclusions We observed markedly greater incidence rates of ischemic stroke subtypes than in other countries within the Mashad Stroke Incidence Study after age standardization. Our findings should be considered when planning prevention and stroke care services in this region.

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Coronary Artery Disease in Patients Presenting With Acute Ischemic Stroke or Transient Ischemic Attack and Elevated Troponin Levels

Frontiers in Neurology ◽

10.3389/fneur.2021.781553 ◽

2022 ◽

Vol 12 ◽

Author(s):

Mathieu Kruska ◽

Anna Kolb ◽

Christian Fastner ◽

Iris Mildenberger ◽

Svetlana Hetjens ◽

...

Keyword(s):

Coronary Artery Disease ◽

Ischemic Stroke ◽

Cardiovascular Risk ◽

Coronary Artery ◽

Transient Ischemic Attack ◽

Large Artery ◽

Elevated Troponin ◽

Stroke Patients ◽

Artery Disease ◽

Ischemic Attack

Background: There is little information concerning the invasive coronary angiography (ICA) findings of patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA) with elevated troponin levels and suspected myocardial infarction (MI). This study analyzed patient characteristics associated with ICA outcomes.Methods: A total of 8,322 patients with AIS or TIA, treated between March 2010 and May 2020, were retrospectively screened for elevated serum troponin I at hospital admission. Patients in whom ICA was performed, due to suspected type 1 MI based on symptoms, echocardiography, and ECG, were categorized according to ICA results (non-obstructive coronary artery disease (CAD): ≥1 stenosis ≥50% but no stenosis ≥80%; obstructive CAD: any stenosis ≥80% or hemodynamically relevant stenosis assessed by FFR/iwFR).Results: Elevated troponin levels were detected in 2,205 (22.5%) patients, of whom 123 (5.6%) underwent ICA (mean age 71 ± 12 years; 67% male). CAD was present in 98 (80%) patients, of whom 51 (41%) were diagnosed with obstructive CAD. Thus, ICA findings of obstructive CAD accounted for 2.3% of patients with troponin elevation and 0.6% of all stroke patients. The clinical hallmarks of myocardial ischemia, including angina pectoris (31 vs. 15%, p < 0.05) and regional wall motion abnormalities (49 vs. 32%, p = 0.07), and increased cardiovascular risk indicated obstructive CAD. While there was no association between lesion site or stroke severity and ICA findings, causal large-artery atherosclerosis was significantly more common in patients with obstructive coronary disease (p < 0.05).Conclusion: The rate of obstructive CAD in patients with stroke or TIA and elevated troponin levels with suspected concomitant type I MI is low. The cumulation of several cardiovascular risk factors and clinical signs of MI were predictive. AIS patients with large-artery atherosclerosis and elevated troponin may represent an especially vulnerable subgroup of stroke patients with risk for obstructive CAD.

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Abstract W P203: Early Recurrence or Worsening of Transient Ischemic Attack or Minor Ischemic Stroke

Stroke ◽

10.1161/str.46.suppl_1.wp203 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Yasumasa Yamamoto ◽

Yoshinari Nagakane ◽

Naoki Makita ◽

Shinji Ashida

Keyword(s):

Ischemic Stroke ◽

Transient Ischemic Attack ◽

Early Recurrence ◽

Stroke Subtype ◽

Stroke Subtypes ◽

Minor Ischemic Stroke ◽

Artery Disease ◽

Ischemic Attack ◽

Total Event ◽

Early Worsening

Purpose: The present study aimed to assess the rate of and predictors for early recurrence or worsening after transient ischemic attack (TIA) or minor ischemic stroke (MIS). Methods: From 1806 consecutive patients with acute ischemic stroke, 474 patients with TIA or MIS have been studied. MIS was defined by an NIH Stroke Scale (NIHSS) score ≤3. The primary outcome was total events that include new-onset stroke or TIA and early worsening in patients with MIS in the first 90 days. Worsening was defined as clinical deterioration by ≥2 points on the NIHSS. Patients were classified into 6 stroke subtypes, i.e., G1: Intracranial atherothrombotic (ATB) (n=53), G2: Extracranial ATB (34), G3: Cardioembolic (85), G4: Penetrating artery (PA) disease (200), G5: Coagulopathy (9), and G6: Other embolism included paradoxical (22), aortogenic (31) and cryptogenic (44) embolism. Patients were also classified into 4 groups in terms of diffusion weighted image (DWI) pattern, i.e., D1: Single cortical and subcortical (n=53), D2: Multiple cortical and subcortical (108), D3: Penetrating artery territory (209) and D4: None (90). Results: Penetrating artery disease as stroke subtype is most prevalent (42.1%). There were 83 total events, of those 65% were worsening. Higher NIHSS (≥2) at admission and positive DWI were significantly higher in the group with events than without (OR: 1.67, 2.39, respectively). Most worsening occurred within 6 days. The incidence of total events/ worsening in different stroke subtypes were G1: 13 (24.5%)/8 (15.0%), G2: 8 (23.4)/4 (11.7), G3: 13 (15.2)/ 8 (9.4), G4: 41 (20.5)/32 (16.0), G5: 2 (22.2) /1 (11.1), and G6: 6 (6.4) /3 (3.2). Total event were higher in G1, G2 and G4, and worsening were higher in G1 (60% of total events) and G4 (80%). The incidence of total events/ worsening in different DWI patterns were D1: 8 (11.9%)/5 (7.4%), D2: 21 (19.4)/14 (12.9), D3: 46 (22.0)/ 36 (17.2), D4: 8 (8.8)/0 (0). Total events were higher in D2 and D3, of those worsening was 66.6% in D2 and 78.2% in D3. Conclusions: A majority of events after TIA/MIS was worsening that is prevalent especially in the patients with intracranial ATB and PA disease and those with high DWI signals of multiple cortical and PA territory. A strategy to halt progressive stroke should be tailored.

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Clinical, Laboratory, and Imaging Characteristics of Transient Ischemic Attack Caused by Large Artery Lesions: A Comparison between Carotid and Intracranial Arteries

Cerebrovascular Diseases Extra ◽

10.1159/000440731 ◽

2015 ◽

Vol 5 (3) ◽

pp. 115-123 ◽

Cited By ~ 3

Author(s):

Toshiyuki Uehara ◽

Tomoyuki Ohara ◽

Kazunori Toyoda ◽

Kazuyuki Nagatsuka ◽

Kazuo Minematsu

Keyword(s):

Ischemic Stroke ◽

Carotid Artery ◽

Transient Ischemic Attack ◽

Clinical Laboratory ◽

Stroke Care ◽

Large Artery ◽

Intracranial Artery ◽

Imaging Characteristics ◽

Artery Disease ◽

Ischemic Attack

Background/Aims: The aims of this study were to determine the differences in clinical characteristics and the risk of ischemic stroke between patients with transient ischemic attack (TIA) attributable to extracranial carotid and intracranial artery occlusive lesions. Methods: Among 445 patients admitted to our stroke care unit within 48 h of TIA onset between April 2008 and December 2013, 85 patients (63 men, mean age 69.4 years) with large artery occlusive lesions relevant to symptoms were included in this study. The primary endpoints were ischemic stroke at 2 and 90 days after TIA onset. Results: Twenty-eight patients had carotid artery occlusive lesions (extracranial group), and 57 patients had intracranial artery occlusive lesions (intracranial group). Patients in the intracranial group were significantly younger, had lower levels of fibrinogen, and were less likely to have occlusion when compared with those in the extracranial group. Eleven patients in the extracranial group and none in the intracranial group underwent revascularization procedures within 90 days of TIA onset. The 2-day risk (14.2 vs. 0%, p = 0.044) and the 90-day risk (17.1 vs. 0%, p = 0.020) of ischemic stroke after TIA onset were significantly higher in the intracranial group than in the extracranial group. Conclusions: Among our patients with TIA caused by large artery disease, patients with intracranial artery occlusive lesions were more frequent and were at higher risk of early ischemic stroke than those with extracranial carotid artery occlusive lesions. These data highlight the importance of prompt assessment of intracranial artery lesions in patients with TIA.

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Prevalence of Microembolic Signals in Embolic Stroke of Undetermined Source and Other Subtypes of Ischemic Stroke

Stroke ◽

10.1161/strokeaha.119.027008 ◽

2020 ◽

Vol 51 (2) ◽

pp. 655-658 ◽

Cited By ~ 3

Author(s):

Eiko Higuchi ◽

Sono Toi ◽

Yuka Shirai ◽

Takao Hoshino ◽

Kentaro Ishizuka ◽

...

Keyword(s):

Ischemic Stroke ◽

Transient Ischemic Attack ◽

Small Vessel Disease ◽

Univariate Analysis ◽

Cerebral Small Vessel Disease ◽

Embolic Stroke ◽

Small Vessel ◽

Large Artery ◽

Vessel Disease ◽

Ischemic Attack

Background and Purpose— Embolic stroke of undetermined source (ESUS) has been proposed to cause thromboembolic infarction from unknown but potential embolic sources. However, an embolus remains undetected in ESUS. The goal of this study was to characterize the prevalence and risk factors of microembolic signals (MESs) in ESUS. Methods— We examined 108 patients with acute ischemic stroke in the internal carotid artery territory or transient ischemic attack within 14 days of symptom onset and who were admitted to our hospital between April 2017 and March 2019. MESs were monitored in the middle cerebral artery on transcranial Doppler for 60 minutes. We examined the prevalence and number of MES in ESUS and other stroke subtypes, such as cardioembolism, large artery atherosclerosis, cerebral small vessel disease, and transient ischemic attack. The present study was registered in University Hospital Medical Information Network Clinical Trials Registry (UMIN000031913). Results— MESs were detected in 33 (31%) of 108 patients. ESUS showed the highest proportion (12/24 [50%]), followed by large artery atherosclerosis (8/20 [40%]), cardioembolism (6/18 [33%]), transient ischemic attack (4/24 [17%]), and cerebral small vessel disease (3/21 [14%]). Univariate analysis showed that higher systolic blood pressure, body mass index, hemoglobin A1c, and ESUS were significantly associated with MES. In multiple logistic regression analysis, ESUS remained significantly associated with MES after adjustment for described covariates from univariate analysis (odds ratio, 2.86 [95% CI, 1.01–8.08]). Conclusions— This study demonstrated significant association of ESUS with MES, supporting the embolic nature of this stroke subtype. Registration— URL: https://upload.umin.ac.jp . Unique identifier: UMIN000031913.

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