Prevalence of stenoses and occlusions of brain-supplying arteries in young stroke patients.
Authorsvon Sarnowski, Bettina
Tobin, William O
Kinsella, Justin A
McCabe, Dominick J H
Hennerici, Michael G
AffiliationFrom the Department of Neurology (B.v.S., U.S., C.K.), University Medicine, Ernst Moritz Arndt University, Greifswald, Germany; Department of Neurology (T.T., J.P.), University Central Hospital, Helsinki, Finland; Department for Biostatistics und Clinical Epidemiology (U.G.), Charité-University Medicine Berlin, Berlin; Department of Neurology (M.K.), Justus Liebig University, Giessen, Germany; Department of Neurology (W.O.T., J.A.K., D.J.H.M.) and Stroke Service (D.J.H.M.), The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital, Trinity College Dublin, Ireland; Department of Clinical Neurosciences (D.J.H.M.), Royal Free Campus, UCL Institute of Neurology, London, UK; Department of Neurology (M.G.H.), UMM, University of Heidelberg, Mannheim, Germany; Department of Neurology (F.F.), Medical University, Graz, Austria; Department of Clinical Neuroscience (B.N.), University Hospital, Lund, Sweden; and Albrecht-Kossel-Institute of Neuroregeneration (A.R.), University of Rostock, Rostock, Germany.
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CitationPrevalence of stenoses and occlusions of brain-supplying arteries in young stroke patients. 2013: Neurology
AbstractOBJECTIVE: Atherosclerosis is believed to be a minor cause of TIA and stroke in younger and middle-aged patients. However, data from large cohorts are limited. This study investigates the prevalence of extracranial and intracranial atherosclerosis in stroke and TIA patients aged 18-55 years in the multinational sifap1 study. METHODS: From the sifap1 cohort (n = 5,023), we analyzed a subset of patients with complete data from carotid ultrasound studies. Patients with arterial dissections, vasculitis, and mobile thrombi were excluded. Among the remaining 2,187 patients (men: n = 1,319; 18-44 years: n = 744), intracranial arteries were additionally examined with ultrasonography in 1,612 patients (73.7%). Patients were stratified by sex and age groups (younger: 18-44 years; middle-aged: 45-55 years). RESULTS: In patients with ischemic stroke, the overall prevalence of carotid artery stenoses and occlusions was 8.9% (younger: 4.9%; middle-aged: 11.0%), of which 81% were symptomatic. Nonstenotic carotid plaques were more common in men than in women (15.8% vs 7.7%; p < 0.001), and in middle-aged than in younger patients (17.0% vs 4.9%; p < 0.001). Supratentorial intracranial artery stenoses and occlusions amounted to 11.8%. Supratentorial stenoses occurred more frequently in middle-aged patients (13.0% vs 7.8%; p < 0.001), whereas occlusions were equally common (both 3.2%; not significant). CONCLUSIONS: We observed a substantial proportion of atherosclerotic carotid artery stenoses and occlusions in younger stroke patients. Intracranial stenoses and occlusions were even more prevalent than extracranial carotid artery disease. Together with nonstenotic plaques, one-fifth of patients (21.2%) had symptomatic or asymptomatic large-artery atherosclerosis, which should encourage future stroke prevention campaigns to target risk factor modification in young people.
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