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

Background and purpose Risk factors for IS in young adults differ between genders and evolve with age, but data on the age‐ and gender‐specific differences by stroke etiology are scare. These features were compared based on individual patient data from 15 European stroke centers. Methods Stroke etio...

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Published in:	European journal of neurology Vol. 20; no. 11; pp. 1431 - 1439
Main Authors:	Yesilot Barlas, N., Putaala, J., Waje-Andreassen, U., Vassilopoulou, S., Nardi, K., Odier, C., Hofgart, G., Engelter, S., Burow, A., Mihalka, L., Kloss, M., Ferrari, J., Lemmens, R., Coban, O., Haapaniemi, E., Maaijwee, N., Rutten-Jacobs, L., Bersano, A., Cereda, C., Baron, P., Borellini, L., Valcarenghi, C., Thomassen, L., Grau, A. J., Palm, F., Urbanek, C., Tuncay, R., Durukan Tolvanen, A., van Dijk, E. J., de Leeuw, F.-E., Thijs, V., Greisenegger, S., Vemmos, K., Lichy, C., Bereczki, D., Csiba, L., Michel, P., Leys, D., Spengos, K., Naess, H., Tatlisumak, T., Bahar, S. Z.
Format:	Journal Article
Language:	English
Published:	England Blackwell Publishing Ltd 01-11-2013 John Wiley & Sons, Inc
Subjects:	Adolescent Adult Brain Ischemia - epidemiology Brain Ischemia - etiology cerebral infarct etiology Europe - epidemiology Female Humans ischaemic stroke (IS) Male Middle Aged Stroke - epidemiology Stroke - etiology stroke in young adults Young Adult Europe ischaemic stroke (IS) stroke in young adults cerebral infarct etiology
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Summary:	Background and purpose Risk factors for IS in young adults differ between genders and evolve with age, but data on the age‐ and gender‐specific differences by stroke etiology are scare. These features were compared based on individual patient data from 15 European stroke centers. Methods Stroke etiology was reported in detail for 3331 patients aged 15–49 years with first‐ever IS according to Trial of Org in Acute Stroke Treatment (TOAST) criteria: large‐artery atherosclerosis (LAA), cardioembolism (CE), small‐vessel occlusion (SVO), other determined etiology, or undetermined etiology. CE was categorized into low‐ and high‐risk sources. Other determined group was divided into dissection and other non‐dissection causes. Comparisons were done using logistic regression, adjusting for age, gender, and center heterogeneity. Results Etiology remained undetermined in 39.6%. Other determined etiology was found in 21.6%, CE in 17.3%, SVO in 12.2%, and LAA in 9.3%. Other determined etiology was more common in females and younger patients, with cervical artery dissection being the single most common etiology (12.8%). CE was more common in younger patients. Within CE, the most frequent high‐risk sources were atrial fibrillation/flutter (15.1%) and cardiomyopathy (11.5%). LAA, high‐risk sources of CE, and SVO were more common in males. LAA and SVO showed an increasing frequency with age. No significant etiologic distribution differences were found amongst southern, central, or northern Europe. Conclusions 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. Click here for the corresponding questions to this CME article.
Bibliography:	Table S1. Proportions of TOAST classification per study site. LAA, large-artery atherosclerosis; CE, cardioembolism; SVO, small-vessel occlusion. Table S2. Regional comparison of etiologic subgroups. Significant differences in univariate comparisons are indicated with a letter: a, south vs. central; b, south vs. north; and c, central vs. north. Helsinki University Central Hospital Research Funds - No. TKK2011110; No. TKK2011003 ark:/67375/WNG-VRC6LJP2-8 ArticleID:ENE12228 istex:13878440FBA73FF7F884AC711E478310FE00E0B8 Finnish Brain Foundation Groupe Lillois de Recherche en Pathologie Vasculaire Finnish Medical Foundation Maire Taponen's Foundation European Neurological Society Western Norway Health ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Article-2 ObjectType-Feature-1
ISSN:	1351-5101 1468-1331
DOI:	10.1111/ene.12228