Subtyping of ischemic stroke based on vascular imaging: analysis of 1,167 acute, consecutive patients.
OBJECTIVE
Knowledge of a patient's cerebral vascular status is essential for accurately classifying stroke. However, vascular evaluations have been incomplete in previous studies, and a stroke registry based on the results of such vascular investigations has not been reported. The purpose of the present study was to classify ischemic strokes based on vascular imaging data.


METHODS
Between May 2001 and August 2003, 1,264 patients with acute (< 7 days) ischemic stroke were admitted to Asan Medical Center. Among them, 1,167 patients (750 men and 417 women; mean age 63.3 years) underwent an angiogram (mostly a magnetic resonance angiogram) and were included in this study. Electrocardiography and computed tomography/magnetic resonance imaging were performed in all patients, while 31.2% underwent echocardiography. The subtypes were categorized with the aid of a modification of the Trial of ORG 10172 in the Acute Stroke Treatment classification.


RESULTS
Large-artery atherosclerosis (LAA) was the most frequent subtype (42%), followed by small-vessel occlusion (SVO, 27%), cardiogenic embolism (CE, 15%), undetermined etiology (15%), and other determined etiology (1.5%). Risk factors included hypertension (71%), cigarette smoking (35%), diabetes mellitus (30%), history of previous stroke (22.7%), emboligenic cardiac diseases (20%), and hypercholesterolemia (11%). Hypertension was more common in patients with SVO than in those with other subtypes (p<0.05), and the case-fatality rate was higher in patients with CE than in those with other subtypes (p<0.01). The functional outcome was worse in patients with LAA than in those with other stroke subtypes (p<0.01).


CONCLUSIONS
According to the stroke registry based on vascular imaging results, LAA was the most common stroke subtype followed by SVD. The high incidence of LAA is probably related to the increased identification of the presence of intracranial atherosclerosis by MR angiogram.
Kim
Jin T
JT
Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea.
Yoo
Sung H
SH
Kwon
Jee-Hyun
JH
Kwon
Sun U
SU
Kim
Jong S
JS
Vasa. 2001 Feb;30(1):43-52
11284090
Eur Neurol. 1999;41(3):135-42
10202244
J Clin Neurol. 2005 Apr;1(1):1-7
20396467
Eur Neurol. 2005;54(2):81-7
16155379
Cerebrovasc Dis. 2000 Mar-Apr;10(2):133-41
10686452
Neurology. 1995 Nov;45(11):1975-9
7501144
Stroke. 1984 Jan-Feb;15(1):56-9
6695431
Ann Neurol. 2005 Nov;58(5):688-97
16240340
Cerebrovasc Dis. 2001;12(3):145-51
11641577
CMAJ. 1999 Oct 19;161(8):989-96
10551199
Mayo Clin Proc. 2006 May;81(5):602-8
16706256
Stroke. 1996 Apr;27(4):650-3
8614924
Cerebrovasc Dis. 2007;23(1):14-9
16968981
Stroke. 1985 Mar-Apr;16(2):182-8
3975954
Stroke. 1997 Dec;28(12):2507-12
9412641
Mayo Clin Proc. 2006 May;81(5):609-14
16706257
Stroke. 1996 Oct;27(10):1760-4
8841325
Stroke. 1993 Jan;24(1):35-41
7678184
Stroke. 1996 Oct;27(10):1765-9
8841326