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Prevalence of stenoses and occlusions of brain-supplying arteries in young stroke patients.

von Sarnowski, Bettina; Schminke, Ulf; Tatlisumak, Turgut; Putaala, Jukka; Grittner, Ulrike; Kaps, Manfred; Tobin, William O; Kinsella, Justin A; McCabe, Dominick J H and Hennerici, Michael G, et al. (2013) In Neurology 80(14). p.1287-1294
Abstract
OBJECTIVE: 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... (More)
OBJECTIVE: 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. (Less)
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Contribution to journal
publication status
published
subject
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Neurology
volume
80
issue
14
pages
1287 - 1294
publisher
American Academy of Neurology
external identifiers
  • wos:000316995800010
  • pmid:23468548
  • scopus:84876370717
ISSN
1526-632X
DOI
10.1212/WNL.0b013e31828ab2ed
language
English
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yes
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6c3a49b5-ae79-4bec-971c-34c11856ced3 (old id 3628481)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/23468548?dopt=Abstract
date added to LUP
2013-04-04 13:58:50
date last changed
2019-10-08 01:18:28
@article{6c3a49b5-ae79-4bec-971c-34c11856ced3,
  abstract     = {OBJECTIVE: 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 &lt; 0.001), and in middle-aged than in younger patients (17.0% vs 4.9%; p &lt; 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 &lt; 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.},
  author       = {von Sarnowski, Bettina and Schminke, Ulf and Tatlisumak, Turgut and Putaala, Jukka and Grittner, Ulrike and Kaps, Manfred and Tobin, William O and Kinsella, Justin A and McCabe, Dominick J H and Hennerici, Michael G and Fazekas, Franz and Norrving, Bo and Kessler, Christof and Rolfs, Arndt},
  issn         = {1526-632X},
  language     = {eng},
  number       = {14},
  pages        = {1287--1294},
  publisher    = {American Academy of Neurology},
  series       = {Neurology},
  title        = {Prevalence of stenoses and occlusions of brain-supplying arteries in young stroke patients.},
  url          = {http://dx.doi.org/10.1212/WNL.0b013e31828ab2ed},
  volume       = {80},
  year         = {2013},
}