Comparison of acute ischemic stroke evaluation and the etiologic subtypes between university and nonuniversity hospitals in Isfahan, Iran

Abstract

Background and purpose Performing a proper causative workup for ischemic stroke patients is essential as it guides the direction of primary and secondary preventions. We aim to investigate the etiological evaluation of these patients in university and nonuniversity hospitals. Method We enrolled subjects from the Persian Registry of Cardiovascular Disease–stroke. Stroke patients were categorized base on an etiological-based classification (Trial of Org 10172 in Acute Stroke Treatment or TOAST) into five groups. We also separated patients with ischemic stroke of undetermined etiology due to incomplete standard evaluation from ischemic stroke of undetermined etiology due to negative standard evaluation. The etiological subtypes and diagnostic evaluations were compared between the two hospital groups. Result Ischemic stroke of undetermined etiology was the most common subtype overall (43%). The prevalence of ischemic stroke of undetermined etiology (incomplete standard evaluation) was significantly higher in patients evaluated in nonuniversity hospitals versus university hospital (46.2% vs. 22.3%). Patients with ischemic stroke of undetermined etiology (negative standard evaluation) and large-artery atherosclerosis were significantly more prevalent in university hospitals (10.3% vs. 4.6% and 13.9% vs. 4.4%, respectively). All diagnostic workups were performed more significantly for university hospital patients. Patients with Ischemic stroke of undetermined etiology (negative standard evaluation). Patients were significantly younger (64.91 ± 14.44 vs. 71.42 ± 12.93) and had lower prevalence of risk factors such as hypertension (48.5% vs. 65.4%) and diabetes (19.4% vs. 33.1%) than patients in ischemic stroke of undetermined etiology (incomplete standard evaluation) subgroup. University hospital patients had better clinical outcomes in terms of mortality and degree of disability during one-year follow-up. Conclusion The high clinical burden of ischemic stroke of undetermined etiology especially in nonuniversity hospitals shows the rational for promoting ischemic stroke evaluation and providing specialized stroke centers for these hospitals in a developing country like Iran.

SARS-CoV-2 and Stroke Characteristics: A Report from the Multinational COVID-19 Stroke Study Group

“…and 21-30% lacune[55,61,62] (SupplementalTable 22). Likewise, we observed lower regional rates of SVO and lacune: in Europe, 4.1% SVO and 9.3% lacune, versus previous reports of 12-31% SVO [63-69]and 14-31% lacune;[65,[70][71][72] in the North and South America, 5.3% SVO and 9.1% lacune, versus reported SVO rates of 15-18%[55,73] and 13-18% lacune;[55,62] and in the Middle Eastern countries, 18.3% SVO and 11.3% lacune, versus 20-25% SVO[56][57][58][59][60]74] and 19-26% lacune.…”

“…[54,55] In the Middle East, our study presented 53.5% LAA, compared with the previously reported rate of 8-31%. [56][57][58][59] Small-vessel occlusion (SVO) accounted for stroke etiology in 10% of our patients, and analysis of neuro-imaging patterns showed 10.2% lacunar infarcts (lacune). These rates are lower than worldwide population-based studies-21-44% SVO, [55,60] [59,75,76] We could not identify any difference in imaging findings or subclasses of the TOAST criteria among SARS-CoV-2 infected patients who presented with chief complaints of stroke-related symptoms compared to patients with a prior diagnosis of SARS-CoV-2 infection.…”

“…[48,49] In our study, 64.4% of the patients under 55 years had AIS. The median age of AIS patients in our study was 68[58-78] years, with no substantial differences across geographical regions (Supplemental Table 10). A case series from New York on 32 AIS patients with SARS-CoV-2 showed a median of 63 years for these patients which was significantly lower than AIS patients without SARS-CoV-2 in the same study and interval (median: 70 years), or historical cohort of the AIS patients presented to the center in 2019 (median: 68.5 years).…”

Left atrial function index in embolic stroke of undetermined source: A case-control study

“…1 Embolic stroke of undetermined source (ESUS) accounts for 9 to 30% of all ischemic strokes, where the exact etiology, pathophysiology, and preventable treatment of the stroke remain unknown. 1,2 Two large randomized trials, the NAVIGATE ESUS and RE-SPECT ESUS which studied rivaroxaban and dabigatran respectively, could not confirm a preventive role for direct oral anticoagulation in ESUS patients. 3,4 The ASSERT study showed an association between subclinical atrial fibrillation (AF) and an increased risk of embolic stroke and ESUS.…”

“Incidence, characteristics and prognosis of cervical artery dissection-induced ischemic stroke in central Iran”

“…Stroke is one of the main causes of mortality and disability worldwide [ 1 ]. Ischemic strokes account for 87% of all strokes in the United States and 76–88% of strokes in Iran [ 2 – 7 ]. During the last decades, the incidence of ischemic strokes among young adults has been increased [ 8 ].…”