title: Prevalence of stenoses and occlusions of brain-supplying arteries in young stroke patients.
abstract: OBJECTIVE
  Atherosclerosis is believed to be a minor cause of TIA and stroke in younger and middle-aged patients. However, data from large cohorts are limited. This study investigates the prevalence of extracranial and intracranial atherosclerosis in stroke and TIA patients aged 18-55 years in the multinational sifap1 study.
  
  
  METHODS
  From the sifap1 cohort (n = 5,023), we analyzed a subset of patients with complete data from carotid ultrasound studies. Patients with arterial dissections, vasculitis, and mobile thrombi were excluded. Among the remaining 2,187 patients (men: n = 1,319; 18-44 years: n = 744), intracranial arteries were additionally examined with ultrasonography in 1,612 patients (73.7%). Patients were stratified by sex and age groups (younger: 18-44 years; middle-aged: 45-55 years).
  
  
  RESULTS
  In patients with ischemic stroke, the overall prevalence of carotid artery stenoses and occlusions was 8.9% (younger: 4.9%; middle-aged: 11.0%), of which 81% were symptomatic. Nonstenotic carotid plaques were more common in men than in women (15.8% vs. 7.7%; p < 0.001), and in middle-aged than in younger patients (17.0% vs. 4.9%; p < 0.001). Supratentorial intracranial artery stenoses and occlusions amounted to 11.8%. Supratentorial stenoses occurred more frequently in middle-aged patients (13.0% vs. 7.8%; p < 0.001), whereas occlusions were equally common (both 3.2%; not significant).
  
  
  CONCLUSIONS
  We observed a substantial proportion of atherosclerotic carotid artery stenoses and occlusions in younger stroke patients. Intracranial stenoses and occlusions were even more prevalent than extracranial carotid artery disease. Together with nonstenotic plaques, one-fifth of patients (21.2%) had symptomatic or asymptomatic large-artery atherosclerosis, which should encourage future stroke prevention campaigns to target risk factor modification in young people.
authors.affiliation: Department of Neurology, University Medicine, Ernst Moritz Arndt University, Greifswald, Germany. Bettina.vonSarnowski@uni-greifswald.de
authors.forename: Bettina
authors.initials: B
authors.lastname: von Sarnowski
authors.forename: Ulf
authors.initials: U
authors.lastname: Schminke
authors.forename: Turgut
authors.initials: T
authors.lastname: Tatlisumak
authors.forename: Jukka
authors.initials: J
authors.lastname: Putaala
authors.forename: Ulrike
authors.initials: U
authors.lastname: Grittner
authors.forename: Manfred
authors.initials: M
authors.lastname: Kaps
authors.forename: William O
authors.initials: WO
authors.lastname: Tobin
authors.forename: Justin A
authors.initials: JA
authors.lastname: Kinsella
authors.forename: Dominick J H
authors.initials: DJ
authors.lastname: McCabe
authors.forename: Michael G
authors.initials: MG
authors.lastname: Hennerici
authors.forename: Franz
authors.initials: F
authors.lastname: Fazekas
authors.forename: Bo
authors.initials: B
authors.lastname: Norrving
authors.forename: Christof
authors.initials: C
authors.lastname: Kessler
authors.forename: Arndt
authors.initials: A
authors.lastname: Rolfs
mesh_terms: D000293:Adolescent; D000328:Adult; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000473:pathology*; D015331:Cohort Studies; D003251:Constriction, Pathologic / Q000453:epidemiology / Q000473:pathology*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D017585:Ultrasonography, Doppler, Transcranial; D055815:Young Adult