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Background: Prospective population-based studies are important to accurately determine the incidence and characteristics of stroke associated with atrial fibrillation (AF), while avoiding selection bias which may complicate hospital-based studies. Methods: We investigated AF-associated stroke within the North Dublin Population Stroke Study, a prospective cohort study of stroke/transient ischaemic attack in 294,592 individuals, according to recommended criteria for rigorous stroke epidemiological studies. Results: Of 568 stroke patients ascertained in the first year, 31.2% (177/568) were associated with AF (90.4%, i.e. 160/177 ischaemic infarcts). The crude incidence rate of all AF-associated stroke was 60/100,000 person-years (95% CI = 52–70). Prior stroke was almost twice as common in AF compared to non-AF groups (21.9 vs. 12.8%, p = 0.01). The frequency of AF progressively increased across ischaemic stroke patients stratified by increasing stroke severity (NIHSS 0–4, 29.7%; 5–9, 38.1%; 10–14, 43.8%; ≥15, 53.3%, p < 0.0001). The 90-day trajectory of recovery of AF-associated stroke was identical to that of non-AF stroke, but Rankin scores in AF stroke remained higher at 7, 28 and 90 days (p < 0.001 for all). Discussion: AF-associated stroke occurred in one third of all patients and was associated with a distinct profile of recurrent, severe and disabling stroke. Targeted strategies to increase anticoagulation rates may provide a substantial benefit to prevent severe disabling stroke at a population level.

In recently symptomatic carotid stenosis, inflammation-related FDG uptake was associated with early stroke recurrence, independent of the degree of stenosis. Plaque FDG-PET may identify patients at highest risk for stroke recurrence, who may be selected for immediate revascularization or intensive medical treatment.

Background and Purpose-Reliable etiologic classification of ischemic stroke may enhance clinical trial design and identification of subtype-specific environmental and genetic risk factors. Although new classification systems (Causative Classification System [CCS] and ASCO [A for atherosclerosis, S for small vessel disease, C for cardiac source, O for other cause]) have been developed to improve subtype assignment, few comparative data exist from large studies. We hypothesized that both CCS and ASCO would reduce the proportion of patients classified as cause undetermined compared with the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) scheme in a large population-based stroke study. Methods-A single rater classified all first-ever ischemic strokes in the North Dublin Population Stroke Study, a population-based study of 294 529 North Dublin residents. Published algorithms for TOAST, CCS, and ASCO were applied. Results-In 381 first-ever ischemic stroke patients, CCS assigned fewer patients as cause undetermined (26.2% versus 39.4%; PϽ0.000001), with increased assignment of cardio-aortic embolism (relative increase 6.9%; Pϭ0.004), large artery atherosclerosis (relative increase 44.1%; Pϭ0.00006), small artery occlusion (relative increase 27.3%; Pϭ0.00006), and other causes (relative increase 91.7%; Pϭ0.001) compared with TOAST. When ASCO grade 1 evidence was applied, fewer patients were classified as small artery disease (relative decrease 29.1%; Pϭ0.007) and more as large artery/atherothrombotic (relative increase 17.6%; Pϭ0.03). ASCO grade 1 did not reduce the proportion of cause undetermined cases compared with TOAST (42.3% versus 39.4%; Pϭ0.2). Agreement between systems ranged from good (ϭ0.61 for TOAST/ASCO grade 1 small artery category) to excellent (ϭ0.95 for TOAST/CCS and ASCO grade 1/CCS cardio/aorto-embolism category). Application of ASCO grades 1 to 3 indicated evidence of large artery/atherosclerosis (73.3%), cardio-embolism (31.3%), small artery (64.7%), and other cause (12%) in TOASTundetermined cases. Conclusion-Both CCS and ASCO schemes showed good-to-excellent agreement with TOAST, but each had specific characteristics compared with TOAST for subtype assignment and data retention. The feasibility of a single combined classification system should be considered. (Stroke. 2010;41:1579-1586.)Key Words: cerebral infarct Ⅲ subtypes Ⅲ causative classification system Ⅲ TOAST Ⅲ ASCO K ey outcomes such as disability, fatality, and recurrence after ischemic stroke differ according to subtype defined by stroke mechanism. 1,2 Identification of the underlying cause of stroke is an important element of daily clinical practice, guiding treatment decisions and prognosis for individual patients. Accurate and reproducible assignment of the likely mechanism of ischemic stroke is also important in clinical trials investigating benefit in specific patient groups 3 (eg, cardioembolic or atherosclerotic stroke) and in epidemiological studies investigating associations between environ- The Trial of ORG 10172 in Acut...

Background and Purpose-Transient ischemic attack (TIA) etiologic data and the ABCD 2 score may improve early stroke risk prediction, but studies are required in population-based cohorts. We investigated the external validity of the ABCD

Background and Purpose-Although symptomatic carotid stenosis is associated with 3-fold increased risk of early stroke recurrence, the pathophysiologic mechanisms of high early stroke risk have not been established. We aimed to investigate the relationship between early stroke recurrence after initial symptoms and histological features of plaque inflammation and instability in resected carotid plaque. Methods-Carotid

Background and Purpose-Statins improve infarct volume and neurological outcome in animal stroke models. We investigated the relationship between statin therapy and ischemic stroke outcome in the North Dublin Population Stroke Study. Methods-A population-based prospective cohort study was performed using rigorous ascertainment methods. Prestroke and acute (Յ72 hours) poststroke medications were recorded. Modified Rankin score and fatality were assessed at 7, 28, and 90 days and 1 year. Results-Of 448 ischemic stroke patients, statins were prescribed before stroke onset in 30.1% (134/445) and were begun acutely (Յ72 hours) in an additional 42.5% (189/445). On logistic regression analysis, adjusting for age, prestroke disability (modified Rankin scale), NIHSS score, hypertension, and aspirin, new poststroke statin therapy was independently associated with improved early and late survival (compared with statin untreated patients: OR for death, 0.12; CI, 0.03-0.54 at 7 days; OR, 0.19; CI, 0.07-0.48 at 90 days; OR, 0.26; CI, 0.12-0.55 at 1 year; PՅ0.006 for all). Similar findings were observed for statin therapy before stroke onset (adjusted OR for death compared with statin-untreated-patients, 0.04; CI, 0.00 -0.33; Pϭ0.003 at 7 days; OR, 0.23; CI, 0.09 -0.58; Pϭ0.002 at 90 days; OR, 0.48; CI, 0.23-1.01; Pϭ0.05 at 1 year). Conclusions-Statin therapy at stroke onset and newly begun statins were associated with improved early and late outcomes, supporting data from experimental studies. Randomized trials of statin therapy for treatment of acute stroke are needed. (Stroke. 2011;42:1021-1029.)Key Words: acute prescription Ⅲ acute stroke Ⅲ neuroprotectants Ⅲ outcomes Ⅲ statins I n randomized trials, 3-hydroxy-3-methylglutaryl coenzyme-A reductase inhibitors (statins) prevent stroke in survivors of first stroke and in other patients at high risk with vascular disease. 1,2 Statins also may improve outcomes after stroke. Infarct volume is reduced by pretreatment or early introduction of statin therapy in experimental acute stroke models. [3][4][5][6][7][8][9] In rodents, statin pretreatment has been associated with reduced neurological disability after focal brain ischemia. 4 -6 Rats treated with atorvastatin 24 hours after focal ischemia had enhanced neurological function, angiogenesis, synaptogenesis, and neuronal progenitor cell migration in the periinfarct region compared to controls. 10 Experimental data Continuing medical education (CME) credit is available for this article. Go to http://cme.ahajournals.org to take the quiz. Received July 12, 2010; accepted November 9, 2010 suggest that statins have vasodilatory, antithrombotic, antiinflammatory, antioxidant, and neuroprotective effects, which may mediate these benefits. 5-7,9 -11 Although providing some support for a neuroprotective role of statins in acute stroke, findings from clinical studies have been inconsistent. Whereas some observational studies have reported reduced mortality or improved functional outcomes in patients treated with statins before stroke on...

Background and Purpose-Transient ischemic attack (TIA) diagnosis is frequently difficult in clinical practice.Noncerebrovascular symptoms are often misclassified as TIA by nonspecialist physicians. Clinical prediction rules such as ABCD 2 improve the identification of patients with TIA at high risk of early stroke. We hypothesized that the ABCD