title: Atherosclerosis in Trial of Org 10172 in Acute Stroke Treatment Subtypes among Young and Middle-Aged Stroke Patients: The Norwegian Stroke in the Young Study.
abstract: BACKGROUND
  Ischemic stroke patients subtyped as of undetermined cause (SUC) usually outnumber those with determined cause subtypes. Etiological stroke classifications may lead to neglect of parallel, noncausative findings. Atherosclerosis progresses over decades and is associated with high morbidity and mortality in young stroke patients in long-term follow-up studies. We compared the prevalence of carotid atherosclerosis in all TOAST subtypes among young patients with acute ischemic stroke.
  
  
  METHODS
  We investigated 150 patients aged 15-60 years with documented acute ischemic stroke, and 84 controls free of cardiovascular disease. Stroke etiology was classified according to TOAST criteria. Carotid intima-media thickness (cIMT) measurements were obtained from 12 standardized multiangle measurements in the common carotid artery, carotid bifurcation, and internal carotid artery.
  
  
  RESULTS
  The causes of stroke were 5.3% large-artery atherosclerosis (LAA), 26.7% cardioembolism, 21.3% small-artery occlusion (SAO), 10% stroke of other determined cause, and 36.7% stroke of undetermined cause (SUC). cIMT was increased in patients with LAA (1.56 mm, P = .002), SAO (1.11 mm, P = .006), and SUC (1.10 mm, P = .004) compared to controls (cIMT 0.86 mm). Segmental cIMT distribution differed across stroke subtypes, age groups, and sexes.
  
  
  CONCLUSIONS
  Atherosclerotic disease is prevalent in the majority of young and middle-aged ischemic stroke patients, requiring determined investigation and aggressive treatment of modifiable risk factors.
authors.affiliation: Centre for Neurovascular Diseases, Department of Neurology, Haukeland University Hospital, Bergen, Norway. Electronic address: atfm@helse-bergen.no.
authors.forename: Annette
authors.initials: A
authors.lastname: Fromm
authors.affiliation: Department of Global Public Health and Primary Health Care, University of Bergen, Bergen, Norway.
authors.forename: Øystein Ariansen
authors.initials: ØA
authors.lastname: Haaland
authors.affiliation: Centre for Neurovascular Diseases, Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway; Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway.
authors.forename: Halvor
authors.initials: H
authors.lastname: Naess
authors.affiliation: Centre for Neurovascular Diseases, Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
authors.forename: Lars
authors.initials: L
authors.lastname: Thomassen
authors.affiliation: Centre for Neurovascular Diseases, Department of Neurology, Haukeland University Hospital, Bergen, Norway.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Waje-Andreassen
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002340:Carotid Artery Diseases / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology*; D059168:Carotid Intima-Media Thickness; D002809:Chondroitin Sulfates / Q000627:therapeutic use*; D003871:Dermatan Sulfate / Q000627:therapeutic use*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006497:Heparan Sulfate / Q000627:therapeutic use*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D009664:Norway / Q000453:epidemiology; D020521:Stroke / Q000145:classification / Q000150:complications* / Q000000981:diagnostic imaging; D055815:Young Adult
chemical_list: D002809:Chondroitin Sulfates; D003871:Dermatan Sulfate; D005343:Fibrinolytic Agents; D006497:Heparan Sulfate; C035838:danaparoid
keywords: TOAST; Young stroke; atherosclerosis; carotid intima–media thickness; ischemic stroke; stroke etiology; ultrasound