Epidemiology of Ischemic Stroke Subtypes According to TOAST Criteria

Kolominsky-Rabas, Peter; Weber, M.; Gefeller, Olaf; Neundoerfer, Bernhard; Heuschmann, Peter U.

doi:10.1161/hs1201.100209

Cited by 1,116 publications

(463 citation statements)

References 40 publications

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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%

“…Large‐artery atherosclerosis followed a similar time course as small‐vessel occlusions. This corresponds to that of other stroke populations 18, 22. However, while some studies have observed higher proportions of large‐artery atherosclerosis earlier in life 23, 24, our population shows that large‐artery atherosclerosis appears in the 3rd decade, but was not a common finding before the 5th decade and thereafter increased until the 8th decade before decreasing again.…”

Section: Discussionsupporting

confidence: 84%

“…We found hypertension as the most frequent risk factor at all ages. Hypertension plays a particular role in small‐vessel occlusion 25 and is also frequently present in large‐artery atherosclerosis 18, 22. There are some indications that large‐artery atherosclerosis and small‐vessel occlusion are coexisting subtypes of stroke 26, supporting the partly atherosclerotic aetiology of small‐vessel occlusion.…”

Section: Discussionmentioning

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: 84%

Section: Discussionmentioning

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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“…Ischemic stroke subtypes were categorized using the TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria. 11 All patients were offered regular follow-up at our clinic. At each follow-up visit, assessment of vascular risk factors was determined as well as any intervention to optimize their control.…”

Section: Data Collectionmentioning

confidence: 99%

Adherence to Guidelines: Experience of a Canadian Stroke Prevention Clinic

Alsalti

Vieira

Côté

2014

Can. J. Neurol. Sci.

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Background: Few studies have assessed the performance of stroke prevention clinics. In particular, limited information exists on patient compliance, achievement of therapeutic targets, and related occurrence of vascular events. Methods: We compared our clinical practice to recommendations from published guidelines in newly referred patients for transient ischemic attack (TIA) or ischemic stroke between 2008 and 2010. We monitored our cohort for at least 1 year and assessed for adequacy of vascular risk factor management, drug adherence, and occurrence of nonlethal vascular outcomes. Results: Of 408 patients, 57.8% had a stroke and 42.2% a TIA. The mean age was 68 ± 13 years, and 52% male. Average follow-up was 15.8 months. During follow-up, 253 patients (70.3%) completely achieved their blood pressure target, 151 (45.5%) achieved their low-density lipoprotein (LDL) cholesterol target, and 407 (99.8%) were on antithrombotics. Eighty-nine patients (21.8%) attained optimal therapy status, defined as reaching targets for LDL cholesterol, blood pressure, and antithrombotic use. Adherence to drug therapy was associated with attainment of optimal therapy status (p = 0.01). Diabetes was associated with lower probability of attaining optimal therapy status (odds ratio [OR], 0.36; 95% confidence interval [CI], 0.20-0.66) and blood pressure targets (OR, 0.09; 95% CI, 0.05-0.17). During follow-up, 52 (12.7%) patients had a nonlethal vascular event. Conclusion: Our study shows good attainment of therapeutic goals associated with adherence to drug therapy. However, optimal therapy status and blood pressure targets were more difficult to attain in patients with diabetes; therefore, more intensive preventive efforts may be required for these individuals.

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“…In population‐based studies, about 30% of IS are caused by cardiac diseases 2, 3. However, there is accumulating evidence that this relationship is not monodirectional and cerebrovascular disorders can conversely alter cardiovascular and autonomic function 4, 5, 6.…”

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confidence: 99%

Stroke‐induced chronic systolic dysfunction driven by sympathetic overactivity

Bieber

Werner

Tanai

et al. 2017

Annals of Neurology

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ObjectiveCardiac diseases are established risk factors for ischemic stroke incidence and severity. Conversely, there is increasing evidence that brain ischemia can cause cardiac dysfunction. The mechanisms underlying this neurogenic heart disease are incompletely understood. Although it is established that ischemic stroke is associated with cardiac arrhythmias, myocardial damage, elevated cardiac enzymes, and plasma catecholamines in the acute phase, nothing is known about the delayed consequences of ischemic stroke on cardiovascular function.MethodsTo determine the long‐term cardiac consequences of a focal cerebral ischemia, we subjected young and aged mice to a 30‐minute transient middle cerebral artery occlusion and analyzed cardiac function by serial transthoracic echocardiography and hemodynamic measurements up to week 8 after surgery. Finally, animals were treated with metoprolol to evaluate a pharmacologic treatment option to prevent the development of heart failure.ResultsFocal cerebral ischemia induced a long‐term cardiac dysfunction with a reduction in left ventricular ejection fraction and an increase in left ventricular volumes; this development was associated with higher peripheral sympathetic activity. Metoprolol treatment prevented the development of chronic cardiac dysfunction by decelerating extracellular cardiac remodeling and inhibiting sympathetic signaling relevant to chronic autonomic dysfunction.InterpretationFocal cerebral ischemia in mice leads to the development of chronic systolic dysfunction driven by increased sympathetic activity. If these results can be confirmed in a clinical setting, treating physicians should be attentive to clinical signs of heart failure in every patient after ischemic stroke. Therapeutically, the successful β‐blockade with metoprolol in mice could also have future clinical implications. Ann Neurol 2017;82:729–743

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Epidemiology of Ischemic Stroke Subtypes According to TOAST Criteria

Cited by 1,116 publications

References 40 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

Adherence to Guidelines: Experience of a Canadian Stroke Prevention Clinic

Stroke‐induced chronic systolic dysfunction driven by sympathetic overactivity

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