Etiology of first‐ever ischaemic stroke in European young adults: the 15 cities young stroke study

Yeşilot, Nilüfer; Putaala, Jukka; Waje‐Andreassen, Ulrike; Vassilopoulou, Sophia; Nardi, Katiuscia; Odier, Céline; Hofgárt, Gergely; Engelter, Stefan T.; Burow, Annika; Mihálka, László; Kloß, Manja; Ferrari, Julia; Lemmens, Robin; Çoban, Oğuzhan; Haapaniemi, Elena; Maaijwee, Noortje A.M.; Rutten-Jacobs, Loes C.A.; Bersano, Anna; Cereda, Carlo; Baron, Pierluigi; Borellini, Linda; Valcarenghi, Caterina; Thomassen, Lars; Grau, Armin J.; Palm, Frederick; Urbanek, Christian; Tunçay, Rezzan; Tolvanen, A. Durukan; Dijk, Ewoud J. van; Leeuw, Frank Erik de; Thijs, Vincent; Greisenegger, Stefan; Vemmos, Konstantinos; Lichy, Christoph; Bereczki, Dániel; Csiba, László; Michel, Patrik; Leys, D.; Spengos, Konstantinos; Næss, Halvor; Tatlısumak, Turgut; Bahar, S.

doi:10.1111/ene.12228

Cited by 167 publications

(129 citation statements)

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“…This is in line with recent studies on young and middle‐aged patients 5, 17, while others have observed a further increase in small‐vessel occlusion at older ages 22. Large‐artery atherosclerosis followed a similar time course as small‐vessel occlusions.…”

Section: Discussionsupporting

confidence: 91%

“…This constellation may be explained by high rates of cardiac disorders with low or uncertain risk, such as patent foramen ovale, among young patients 5, 19, 20, whereas high‐risk disorders, such as atrial fibrillation, increased dramatically with age 19, 20. The present data support this, as we identified AF as an important risk factor from the 4th decade, thereafter consistently increasing throughout the 10th decade.…”

Section: Discussionsupporting

confidence: 81%

“…In our study, the proportion of this subtype declined steeply during mid‐age and was non‐existent among the elderly. Other young stroke studies also support a decline of stroke of other determined cause towards mid‐age, although their rates declined more gently than in our study 5, 17.…”

Section: Discussionsupporting

confidence: 73%

“…The aetiology of stroke is influenced by sex, race and age, as well as by cultural and geographic factors 1, 2, 3, 4, 5, 6. Stroke subtypes are commonly categorized as large‐artery atherosclerosis (LAA), cardioembolism (CE), small‐vessel occlusion (SVO), stroke of other determined cause (SOC) and stroke of undetermined cause (SUC) (TOAST criteria) 7.…”

Section: Introductionmentioning

confidence: 99%

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Age dependency of ischaemic stroke subtypes and vascular risk factors in western Norway: the Bergen Norwegian Stroke Cooperation Study

et al. 2015

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ObjectivesAge dependency of acute ischaemic stroke aetiology and vascular risk factors have not been adequately evaluated in stroke patients in Norway. Aims of this study were to evaluate how stroke subtypes and vascular risk factors vary with age in a western Norway stroke population.Materials and methodsPatients aged 15–100 years consecutively admitted to our neurovascular centre with acute ischaemic stroke between 2006 and 2012 were included. The study population was categorized as young (15–49 years), middle‐aged (50–74 years) or elderly (≥75 years). Stroke aetiology was defined by TOAST criteria. Risk factors and history of cardiovascular disease were recorded.ResultsIn total, 2484 patients with acute cerebral infarction were included: 1418 were males (57.3%). Mean age was 70.8 years (SD ± 14.9), 228 patients were young, 1126 middle‐aged, and 1130 were elderly. The proportion of large‐artery atherosclerosis and of small‐vessel occlusion was highest among middle‐aged patients. The proportion of cardioembolism was high at all ages, especially among the elderly. The proportion of stroke of other determined cause was highest among young patients. Some risk factors (diabetes mellitus, active smoking, angina pectoris, prior stroke and peripheral artery disease) decreased among the elderly. The proportions of several potential causes increased with age.ConclusionThe proportion of stroke subtypes and vascular risk factors are age dependent. Age 50–74 years constitutes the period in life where cardiovascular risk factors become manifest and stroke subtypes change.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 81%

Section: Discussionsupporting

confidence: 73%

Section: Introductionmentioning

confidence: 99%

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Age dependency of ischaemic stroke subtypes and vascular risk factors in western Norway: the Bergen Norwegian Stroke Cooperation Study

et al. 2015

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“…Despite extensive etiologic workup, one third of IS in the young remains without identified pathogenesis (ie, cryptogenic IS). 1,3,4 Data on clinical outcomes in young patients with cryptogenic IS are limited.…”

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confidence: 99%

Prevalence of Fabry Disease and Outcomes in Young Canadian Patients With Cryptogenic Ischemic Cerebrovascular Events

Lanthier

Saposnik²,

Lebovic³

et al. 2017

Stroke

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Background and Purpose-Previous studies reported Fabry disease in 0% to 4% of young patients with cryptogenic ischemic stroke (IS). We sought to determine the prevalence of Fabry and outcomes among young Canadians with cryptogenic IS or transient ischemic attack (TIA). Methods-We prospectively enrolled individuals aged 18 to 55 with IS or speech or motor TIA, and no cause identified despite predetermined investigation. α-galactosidase-A gene was sequenced for Fabry diagnosis. National Institutes of Health Stroke Scale score was measured at presentation to quantify stroke severity. Modified Rankin Scale determined functional outcomes ≤7 days after presentation and 6 months later. Results-We enrolled 365 patients with IS and 32 with TIA. α-galactosidase-A sequencing identified a single carrier of a genetic variant of unknown significance (p.R118C) and no well-recognized pathogenic variants. Mean National Institutes of Health Stroke Scale score was 3.1. Proportion of patients with modified Rankin Scale of 0 to 2 was 70.7% at ≤7 days and 87.4% at 6 months. National Institutes of Health Stroke Scale score at presentation and diabetes mellitus predicted 6-month modified Rankin Scale. Thirteen patients experienced 5 recurrent IS and 9 TIA during follow-up. No patient died. Most patients (98.7%) returned home. Among previous workers, 43% had residual working limitations. Conclusions-In this Canadian cohort of patients with cryptogenic IS or TIA, the prevalence of Fabry was 0.3% if p.R118C variant is considered as pathogenic. This suggests that more cost-effective methods should be applied for diagnosis of Fabry rather than systematic genetic screening in this population. Overall, cryptogenic IS in young adults is associated with favorable outcomes.

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Effect ofASAon the risk of cerebrovascular ischemic events in patients withPFO

Zhou

Pan

et al. 2022

Ann Clin Transl Neurol

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Background Whether atrial septal aneurysm (ASA) increases the risk of cerebrovascular ischemic events in patients with patent foramen ovale (PFO) remains controversial. Objective We constructed a detailed meta‐analysis to assess the effect of ASA on risk of cerebrovascular ischemic events in patients with PFO. Methods Randomized controlled trials (RCTs) and observational studies (cohort studies and case‐control studies) that compared PFO‐ASA against PFO alone were included. Pooled odds ratios (OR) estimates and 95% CI were calculated using the fixed‐effect and random‐effect models. Results Four RCTs and twelve observational studies (five cohort studies and seven case‐control studies) contributed to the meta‐analysis. The pooled results of case‐control studies showed that ASA increased the risk of cerebrovascular ischemic events in patients with PFO (fixed‐effect model: OR = 3.69; 95% CI: 2.67–5.09; p < 0.01, random‐effect model: OR = 3.63; 95% CI: 2.51–5.24; p < 0.01). However, poole results from RCTs (fixed‐effect model: OR = 1.24; 95% CI: 0.78–1.95; p = 0.36, random‐effect model: OR = 1.27; 95% CI: 0.78–2.08; p = 0.34) and cohort studies (fixed‐effect model: OR = 1.35; 95% CI: 0.81–2.23; p = 0.25, random‐effect model: OR = 1.40; 95% CI: 0.84–2.33; p = 0.20) found no evidence. Overall analysis showed that ASA increased the risk of cerebrovascular ischemic events (fixed‐effect model: OR = 2.30; 95% CI: 1.84–2.87; p < 0.01, random‐effect model: OR = 2.11; 95% CI: 1.48–3.01; p < 0.01). The sensitivity analysis confirmed the stability of all results. Conclusions Although case‐control studies support ASA to increase the risk of cerebrovascular ischemic events in patients with PFO, RCTs and cohort studies challenged the credibility. Further prospective studies are needed to confirm the effect of ASA on patients with PFO.

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Etiology of first‐ever ischaemic stroke in European young adults: the 15 cities young stroke study

Abstract: The etiology of IS in young adults has clear gender-specific patterns that change with age. A notable portion of these patients remains without an evident stroke mechanism according to TOAST criteria.

Cited by 167 publications

References 37 publications

Age dependency of ischaemic stroke subtypes and vascular risk factors in western Norway: the Bergen Norwegian Stroke Cooperation Study

Age dependency of ischaemic stroke subtypes and vascular risk factors in western Norway: the Bergen Norwegian Stroke Cooperation Study

Prevalence of Fabry Disease and Outcomes in Young Canadian Patients With Cryptogenic Ischemic Cerebrovascular Events

Effect ofASAon the risk of cerebrovascular ischemic events in patients withPFO

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