Secular Trends for Etiologies of Acute Ischemic Stroke in Young Adults

Amir Shaban; Vaelan Molian; Aayushi Garg; Kaustubh Limaye; Enrique C Leira; Harold P Adams Jr

doi:10.1016/j.jstrokecerebrovasdis.2020.105270

Secular Trends for Etiologies of Acute Ischemic Stroke in Young Adults

J Stroke Cerebrovasc Dis. 2020 Dec;29(12):105270. doi: 10.1016/j.jstrokecerebrovasdis.2020.105270. Epub 2020 Sep 6.

Authors

Amir Shaban¹, Vaelan Molian², Aayushi Garg², Kaustubh Limaye², Enrique C Leira³, Harold P Adams Jr²

Affiliations

¹ Departments of Neurology, College of Public Health, University of Iowa, Iowa City, Iowa (USA). Electronic address: amir-shaban@uiowa.edu.
² Departments of Neurology, College of Public Health, University of Iowa, Iowa City, Iowa (USA).
³ Departments of Neurology, College of Public Health, University of Iowa, Iowa City, Iowa (USA); Neurosurgery, University of Iowa, Iowa City, Iowa (USA); Carver College of Medicine, and Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa (USA).

PMID: 32992166
DOI: 10.1016/j.jstrokecerebrovasdis.2020.105270

Abstract

Background: Ischemic stroke is not rare among young adults. Understanding secular trends in the mechanism of ischemic stroke in young adults may help guide evaluation and secondary prevention. This study compares the mechanism of ischemic stroke and diagnostic studies in two groups of young adults treated at the University of Iowa 20 years apart.

Methods: We retrospectively reviewed all patients aged 15-45 who presented to the University of Iowa Hospitals between 1/2010-11/2016 with ischemic stroke confirmed by imaging. Diagnostic studies and stroke etiologies for each patient using the TOAST criteria were reviewed and compared to a historic sample of young patients of the same age who presented to our center in 1977-1993.

Results: We identified 322 young adults, 165 (51.2%) were women. The mean age was 36.3 ± 7.2 years. Vessel imaging was performed in 317 (95.2%) cases vs. 68.9% in the historic sample. Of these, 259 (80.4%) had magnetic resonance angiography (MRA), while diagnostic angiogram was the sole modality used for vessel imaging in the historic sample. Transthoracic echocardiography (TTE) was performed in 101 (31.4%) and transesophageal echocardiography (TEE) was performed in 169 (52.5%) cases compared to 67.1% who underwent TTE in the historic sample. In comparison with the historic sample, there was a significant decline in strokes due to small vessel disease [odds ratio (OR) 0.49, 95% confidence intervals (CI) 0.25-0.97]. The most common etiology of stroke in our sample was cervical artery dissection in 79 (24.5%) patients, whereas this was found in only 6.0% of patients in the historic sample [OR 5.0 and CI (2.99-8.44).

Conclusions: Using the TOAST classification, cryptogenic stroke remained the most common subtype in young adults. While the most common cause for ischemic stroke was cervical artery dissection.

Disclosures: Enrique Leira receive salary support from the National Institute of Health.

Keywords: Cervical artery dissection; Diagnostic studies; Ischemic stroke; Neuroimaging; Stroke etiology; Young people.

Publication types

Comparative Study

MeSH terms

Adolescent
Adult
Age Factors
Brain Ischemia / diagnostic imaging
Brain Ischemia / etiology*
Female
Humans
Iowa
Male
Middle Aged
Registries
Retrospective Studies
Risk Assessment
Risk Factors
Stroke / diagnostic imaging
Stroke / etiology*
Time Factors
Young Adult