1. Distribution of Cardioembolic Stroke: A Cohort Study.
- Author
-
Pierik R, Algra A, van Dijk E, Erasmus ME, van Gelder IC, Koudstaal PJ, Luijckx GR, Nederkoorn PJ, van Oostenbrugge RJ, Ruigrok YM, Scheeren TWL, Uyttenboogaart M, Visser MC, Wermer MJH, and van den Bergh WM
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Brain Ischemia diagnostic imaging, Brain Ischemia physiopathology, Cerebrovascular Circulation, Child, Child, Preschool, Female, Heart Diseases diagnostic imaging, Humans, Infant, Infant, Newborn, Male, Middle Aged, Netherlands, Prospective Studies, Registries, Risk Assessment, Risk Factors, Stroke diagnostic imaging, Stroke physiopathology, Thromboembolism diagnostic imaging, Thromboembolism physiopathology, Young Adult, Brain Ischemia etiology, Heart Diseases complications, Stroke etiology, Thromboembolism etiology
- Abstract
Background: A cardiac origin in ischemic stroke is more frequent than previously assumed, but it is not clear which patients benefit from cardiac work-up if obvious cardiac pathology is absent. We hypothesized that thromboembolic stroke with a cardiac source occurs more frequently in the posterior circulation compared with thromboembolic stroke of another etiology., Methods: We performed a multicenter observational study in 3,311 consecutive patients with ischemic stroke who were enrolled in an ongoing prospective stroke registry of 8 University hospitals between September 2009 and November 2014 in The Netherlands. In this initiative, the so-called Parelsnoer Institute-Cerebrovascular Accident Study Group, clinical data, imaging, and biomaterials of patients with stroke are prospectively and uniformly collected. We compared the proportions of posterior stroke location in patients with a cardiac stroke source with those with another stroke etiology and calculated risk ratios (RR) with corresponding 95% CI with Poisson regression analyses. To assess which patient or disease characteristics were most strongly associated with a cardiac etiology in patients with ischemic stroke, we performed a stepwise backward regression analysis., Results: For the primary aim, 1,428 patients were eligible for analyses. The proportion of patients with a posterior stroke location among patients with a cardiac origin of their stroke (28%) did not differ statistically significant to those with another origin (25%), age and sex adjusted RR 1.16; 95% CI 0.96-1.41. For the secondary aim, 1,955 patients were eligible for analyses. No recent history of smoking, no hyperlipidemia, coronary artery disease, a higher age, and a higher National Institutes of Health Stroke Scale (NIHSS) score were associated with a cardiac etiology of ischemic stroke., Conclusions: We could not confirm our hypothesis that thromboembolic stroke localized in the posterior circulation is associated with a cardioembolic source of ischemic stroke, and therefore posterior stroke localization on itself does not necessitate additional cardiac examination. The lack of determinants of atherosclerosis, for example, no recent history of smoking and no hyperlipidemia, coronary artery disease, a higher age, and a higher NIHSS score are stronger risk factors for a cardiac source of ischemic stroke., (© 2020 The Author(s) Published by S. Karger AG, Basel.)
- Published
- 2020
- Full Text
- View/download PDF