Introduction:
Branch atheromatous disease (BAD) and aortogenic embolism (Ao) are categorized as “unclassified” in accordance with “The Trial of Org 10172 in Acute Stroke Treatment (TOAST)” classification; however, their pathophysiology is similar to that of atherothrombosis (AT). We compared these categories of ischemic cerebrovascular disease (iCVD).
Methods:
A consecutive series of 1,079 patients with iCVD 7 days within onset were included. According to TOAST classification, 180 (16.7%), 159 (14.7%), 251 (23.3%), and 489 (45.3%) patients were classified as AT, lacunar, cardiogenic embolism, and unclassified, respectively. Of the unclassified, 145 and 82 patients were re-classified as Ao and BAD, respectively.
Results:
Mean age was 75.3, 75.7, and 73.0 years in AT, Ao, and BAD, respectively. Male predominance was most apparent in AT (62.6%), followed by BAD (54.7%) and Ao (54.6%). Prevalence of hypertension, diabetes mellitus, and dyslipidemia was 80.7%, 39.4%, and 53.6% in AT, 83.8%, 30.5%, and 53.9% in Ao, and 74.7%, 33.3%, and 57.3% in BAD, respectively. Hemodialysis was more common in Ao (6.7%) than in BAD (2.7%) and AT (0.7%). Median (IQR) of National Institutes of Health Stroke Scale score on admission and at discharge was 3 (1-6) and 1 (1-3) in AT, 2 (0-4) and 0 (0-2) in Ao, and 5 (3-6) and 2 (1-5) in BAD, respectively. Neurological deterioration was more frequent in BAD (30.7%) than in AT (16.1%) and Ao (2.6%). Median (IQR) of modified Rankin scale (mRS) prior to iCVD and at discharge was 0 (1-2) and 2 (0-4) in AT, 0 (0-1) and 1 (0-2.25) in Ao, and 0 (0-1) and 2 (1-4) in BAD, respectively. The percentage of patients with mRS 2 or better prior to onset and at discharge was 83.2% and 63.9% in AT, 88.3% and 75.3% in Ao, and 89.3% and 58.7% in BAD, respectively. Recurrence of iCVD at 3 months after onset was more frequent in AT (12.9%) than in Ao (9.7%) and BAD (5.3%).
Conclusions:
Ao and BAD have many similarities with AT, but there are some differences. In Ao, symptoms were often mild and rarely worsened, but with recurrence of up to 10%. There were many dialysis patients in Ao. Worsening was observed in more than 30% of patients, and outcomes were often poor, but recurrences were few in BAD patients.