Phenotypic ASCOD characterisations of ischaemic stroke in the young at an urban tertiary care centre

Abstract

Background and purposeStroke in young individuals is a serious public health burden. This study aimed to characterise the various phenotypes of ischaemic stroke in a young urban population (≤50 years old) using the ASCOD classification system, which assigns a score to five stroke categories: atherosclerosis, small vessel disease (SVD), cardioembolism, other and dissection. Within each category, a numerical score represents the degree of causality attributed to the stroke.MethodsThis retrospective study cohort was composed of patients from an urban tertiary care academic centre. Cases were selected by searching Get With the Guidelines database for adults ≤50 years old with ischaemic stroke. The study sample included 175 ischaemic strokes in 157 patients, with 16 subjects re-infarcting. Using retrospective chart review, each stroke was scored according to the ASCOD classification system. Multivariable logistic regression analyses were performed to explore each ASCOD category’s association with causal risk factors.ResultsOf possible causal mechanisms, defined as receiving a grade 1 or 2, a cardiovascular aetiology was most prevalent (25.7%), followed by SVD (22.3%), and closely by atherosclerosis (21.1%). Of general phenotypes, defined as receiving a grade 1 or 2 or 3, atherosclerosis was the most prevalent (51.4%), followed by SVD (47.4%), cardioembolism (42.3%) and other (35.4%). 31.6% of all strokes were of unclear aetiology. Subjects between 45 and 50 years old were more likely to develop a cardioembolic or SVD stroke when compared with subjects <45 years old.ConclusionThis study took a novel approach to ASCOD phenotyping, allowing several observations: (1) In patients with advanced atherosclerosis receiving the score A1, the vast majority had systemic atherosclerosis in multiple vascular territories; (2) the cardiac score C2(6), defined as a radiographic pattern highly suggestive of a central embolic source, may overestimate the prevalence of true cardiac disease; (3) incidental laboratory findings may detect some underlying pathology, but causality to the stroke is unlikely.

Compound Shenma Jingfu Granule alleviates cerebral ischemia via HIF-1α-mediated promotion of angiogenesis

“…Stroke, encompassing ischemic and hemorrhagic categories, is the leading global cause of death and disability [1]. In the past thirty years, the incidence of cerebral ischemia has been increasing [2], especially among those under 55 [3],…”

Compound Shenma Jingfu granule alleviates cerebral ischemia via HIF-1α-mediated promotion of angiogenesis

“…Stroke, encompassing ischemic and hemorrhagic categories, is the leading global cause of death and disability [ 1 ]. In the past thirty years, the incidence of cerebral ischemia has been increasing [ 2 ], especially among those under 55 [ 3 ], underscoring the need for more effective therapeutic and preventive strategies. Cerebral ischemia injury involves initial injury during ischemia and subsequent reperfusion-induced damage [ 4 ], driven by mitochondrial dysfunction, elevated oxidative stress/reactive oxygen species (ROS), blood–brain barrier (BBB) disruption, inflammation, and apoptosis [ 5 ].…”

Non-coding RNAs are key players and promising therapeutic targets in atherosclerosis

“…The prevalence of AS is high and underlies most CVDs, leading to high-mortalityrate manifestations, such as acute coronary syndrome and myocardial infarction (Falk, 2006;Xie et al, 2020). Early AS has no obvious symptoms; thus, early screening for AS is necessary to effectively prevent high-risk CVD (Liu et al, 2018). Imaging remains the primary means for early AS diagnosis, and due to advances in medical technology, some molecular markers shown promise for improving AS screening (Meng H. et al, 2022).…”