Acute ischaemic stroke in the absence of established vascular risk factors: Patient characteristics, stroke mechanism and long‐term outcome. (7th December 2020)

• Record Type: Journal Article
• Authors: Nannoni, Stefania; Scherz‐Moussa Youma, Ali; Amiguet, Michael; Eskandari, Ashraf; Strambo, Davide; Michel, Patrik
• Is Part Of: European journal of neurology. Volume 28:Number 4(2021)
• Page Start: 1275
• Page End: 1283
• Publication Date: 2020-12-07
• Subjects: acute ischaemic stroke -- stroke etiology -- stroke in the young -- vascular risk factor; Neurology -- Periodicals; Nervous system -- Diseases -- Periodicals; 616.8
• DOI: 10.1111/ene.14667
• Languages: English
• ISSNs: 1351-5101

Abstract

Abstract: 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 : Of a cohort of 4889 patients with acute ischaemic stroke, 2% showed no established vascular risk factors (EVRFs) after a comprehensive work‐up. The absence of EVRFs was independently associated with the presence of patent foramen ovale and contraceptive use in younger patients and with female sex and active cancer in elderly patients. Despite their more favorable risk profile, patients with stroke and no EVRFs had worse long‐term outcomes compared to patients with stroke and at least one EVRF.