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Background and purpose: There is scarce clinical information about the clinical profile of patients with acute ischaemic stroke with previously undiagnosed major vascular risk factors (UMRFs). Methods: This was a retrospective analysis of data from the Acute Stroke Registry and Analysis of Lausanne registry between 2003 and 2018 with univariate and multivariate logistic regression analyses comparing clinical profiles of patients with UMRFs to patients with at least one previously diagnosed MRF (DMRF). Results: In all, 4354 patients (median age 70 years [interquartile range 15.2], 44.7% female) were included after excluding 763 (14.9%) for lack of consent and three for missing information. Amongst 1125 (25.8%) UMRF patients, 69.7% (n = 784) had at least one newly diagnosed MRF and the others none. The newly detected MRFs were dyslipidaemia (61.4%), hypertension (23.7%), atrial fibrillation (10.2%), diabetes mellitus (5.2%), ejection fraction <35% (2.0%) and coronary disease (1.0%). Comparing UMRF patients to DMRF patients, multivariate analysis showed a positive association with lower age, non‐Caucasian ethnicity, contraceptive use (<55 years old), smoking (≥55 years old) and patent‐foramen‐ovale‐related stroke mechanism. A negative association was found with pre‐stroke antiplatelet use and higher body mass index. Functional outcome did not differ. Cerebrovascular recurrences were similar between groups. Conclusions: In this large single‐centre cohort, 69.7% of patients with acute ischaemic stroke and UMRF were newly diagnosed with at least one new MRF, the most common being dyslipidaemia, hypertension or atrial fibrillation. Patients of the UMRF group were younger, more often smokers and on contraceptives, and had more patent‐foramen‐ovale‐related strokes. [ABSTRACT FROM AUTHOR]

Background: Rare mechanisms of stroke (RMS) in acute ischemic stroke (AIS) have rarely been studied applying a systematic approach. Our aim was to define the frequency, etiologies, predictors, and outcomes of RMS in a consecutive series of AIS. Methods: Data from consecutive patients from 2003 to 2016 were derived from the Acute STroke Registry and Analysis of Lausanne (ASTRAL). Frequency of subcategories of RMS was calculated. In a case–control design, RMS were compared to strokes of all other mechanisms. Outcome was assessed with 3-month Rankin-shift and 12-month mortality and recurrence rates. Results: Out of 4154 AISs, 222 (5.3%) were found to have a RMS (42.0% female, median age 66 years). The most frequent RMS etiologies were medical interventions (25.6%), active oncological disease (22.5%), and vasculitis (11.7%). In multivariate analysis, RMS patients were younger, had more preceding and bilateral strokes, and a higher admission temperature. They were associated with less traditional risk factors and more systemic disease (such as AIDS, coagulopathy, and cancer). RMS also had more early ischemic changes on plain CT, less revascularization treatments, and more symptomatic hemorrhagic transformations. They presented significantly higher 3-month disability (Rankin-shift-ORadj 1.74), 12-month recurrence (ORadj 1.99), and mortality rates (ORadj 2.41). Conclusions: RMS occurred in 5.3% of a large population of consecutive AISs and are most frequently related to medical interventions, cancer, and vasculitis. RMS patients have less traditional risk factors but more systemic comorbidities, hemorrhagic transformations, recurrences, and a worse long-term outcome. Identification of RMS has direct implications for early treatment and long-term outcome. [ABSTRACT FROM AUTHOR]

Background and purpose: In‐hospital strokes (IHS) are associated with longer diagnosis times, treatment delays and poorer outcomes. Strokes occurring in the stroke unit have seldom been studied. Our aim was to assess the management of in‐stroke‐unit ischaemic stroke (ISUS) by analysing ISUS characteristics, delays in diagnosis, treatments and outcomes. Methods: Consecutive patients from the Acute Stroke Registry and Analysis of Lausanne (ASTRAL), from January 2003 to June 2019, were classified as ISUS, other‐IHS or community‐onset stroke (COS). Baseline and stroke characteristics, time to imaging and time to treatment, missed treatment opportunities, treatment rates and outcomes were compared using multivariate analysis with adjustment for relevant clinical, imaging and laboratory data available in ASTRAL. Results: Amongst the 3456 patients analysed, 138 (4.0%) were ISUS, 214 (6.2%) other‐IHS and 3104 (89.8%) COS. In multivariate analysis, patients with ISUS more frequently had known stroke onset time than other‐IHS (adjusted odds ratio [aOR] 2.44; 95% confidence interval [CI] 1.39–4.35) or COS (aOR 2.56; 95% CI 1.59–4.17), had fewer missed treatment opportunities than other‐IHS (aOR 0.22; 95% CI 0.06–0.86) and higher endovascular treatment (EVT) rates than COS (aOR 3.03; 95% CI 1.54–5.88). ISUS was associated with a favourable shift in the modified Rankin Scale at 3 months in comparison with other‐IHS (aOR 1.73; 95% CI 1.11–2.69) or COS (aOR 1.46; 95% CI 1.00–2.12). Conclusion: In‐stroke‐unit ischaemic stroke more frequently had known stroke onset time than other‐IHS or COS, fewer missed treatment opportunities than other‐IHS and a higher EVT rate than COS. This readiness to identify and treat patients in the stroke unit may explain the better long‐term outcome of ISUS. [ABSTRACT FROM AUTHOR]

Background and purpose: Some acute ischaemic stroke (AIS) patients do not display established vascular risk factors (EVRFs). The aim was to assess their clinical characteristics, stroke subtype etiological classification and long‐term outcome. Methods: All consecutive AIS patients from the Acute Stroke Registry of Lausanne (2003–2018) were retrospectively analyzed with complete assessment of the following EVRFs: hypertension, diabetes, major cardioembolic sources, dyslipidemia, smoking, obesity, alcohol abuse, previous stroke/transient ischaemic attack and depression/psychosis. Patients without EVRFs were compared to patients with one or more EVRFs using appropriate statistical models. Results: Of 4889 included patients, 103 (2.1%) had no EVRFs. In multiple regression analysis, patients without EVRFs were significantly younger (odds ratio [OR] 0.13; 95% confidence interval [CI] 0.08–0.20) and had more multiterritorial strokes (OR 3.38; 95% CI 1.26–9.05). Strokes were more often related to patent foramen ovale (PFO) (OR 3.02; 95% CI 1.44–6.32) and less to atherosclerosis, cardioembolism or small vessel disease. In patients <55 years old, PFO (OR 2.76; 95% CI 1.50–5.08) and contraceptive use in females (OR 2.75; 95% CI 1.40–5.41) were more frequent, whereas sleep apnea syndrome (OR 0.09; 95% CI 0.01–0.63) was less. In patients ≥55 years, female sex (OR 2.84; 95% CI 1.43–5.65) and active cancer (OR 3.27; 95% CI 1.34–7.94) were more prevalent. At 12 months, patients without EVRFs had worse adjusted functional outcome (Rankin shift ORadj 0.63; 95% CI 0.42–0.95) and higher rate of recurrence and death (adjusted hazard ratio 2.11; 95% CI 1.19–3.74). Conclusions: In a consecutive cohort of AIS patients, only 2% showed no EVRFs. PFO and contraceptive use exhibited a strong association with the absence of EVRFs in younger patients and female sex and active cancer in elderly patients. Our findings highlight the importance of searching for previously unknown risk factors and/or unusual stroke mechanisms in patients without EVRFs. [ABSTRACT FROM AUTHOR]