Rare stroke mechanisms in 4154 consecutive patients: causes, predictors, treatment, and outcomes

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...

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Veröffentlicht in:	Neurological sciences Jg. 43; H. 11; S. 6359 - 6369
Hauptverfasser:	Vicino, Alex, Sirimarco, Gaia, Eskandari, Ashraf, Lambrou, Dimitris, Maeder, Philippe, Dunet, Vincent, Michel, Patrik
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	Cham Springer International Publishing 01.11.2022 Springer Nature B.V
Schlagworte:	Comorbidity Hemorrhage Ischemia Medical treatment Medicine Medicine & Public Health Mortality Multivariate analysis Neurology Neuroradiology Neurosciences Neurosurgery Original Original Article Patients Psychiatry Risk factors Stroke Vasculitis Rare stroke Stroke mechanism Ischemic stroke
ISSN:	1590-1874, 1590-3478, 1590-3478
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Abstract	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-OR adj 1.74), 12-month recurrence (OR adj 1.99), and mortality rates (OR adj 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.
AbstractList	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-OR adj 1.74), 12-month recurrence (OR adj 1.99), and mortality rates (OR adj 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. 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.BACKGROUNDRare 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.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.METHODSData 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.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).RESULTSOut 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).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.CONCLUSIONSRMS 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. BackgroundRare 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.MethodsData 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.ResultsOut 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).ConclusionsRMS 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.
Author	Vicino, Alex Sirimarco, Gaia Maeder, Philippe Eskandari, Ashraf Lambrou, Dimitris Michel, Patrik Dunet, Vincent
Author_xml	– sequence: 1 givenname: Alex orcidid: 0000-0001-6420-8124 surname: Vicino fullname: Vicino, Alex email: alex.vicino@chuv.ch organization: Stroke Center, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne – sequence: 2 givenname: Gaia surname: Sirimarco fullname: Sirimarco, Gaia organization: Stroke Center, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne – sequence: 3 givenname: Ashraf surname: Eskandari fullname: Eskandari, Ashraf organization: Stroke Center, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne – sequence: 4 givenname: Dimitris surname: Lambrou fullname: Lambrou, Dimitris organization: Stroke Center, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne – sequence: 5 givenname: Philippe surname: Maeder fullname: Maeder, Philippe organization: Diagnostic Neuroradiological Unit, Service of Diagnostic and Interventional Radiology, Department of Medical Radiology, Lausanne University Hospital and University of Lausanne – sequence: 6 givenname: Vincent surname: Dunet fullname: Dunet, Vincent organization: Diagnostic Neuroradiological Unit, Service of Diagnostic and Interventional Radiology, Department of Medical Radiology, Lausanne University Hospital and University of Lausanne – sequence: 7 givenname: Patrik surname: Michel fullname: Michel, Patrik organization: Stroke Center, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne
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Keywords	Rare stroke Stroke mechanism Ischemic stroke
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Cerebrovasc Dis. doi: 10.1159/000015866
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Snippet	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... BackgroundRare mechanisms of stroke (RMS) in acute ischemic stroke (AIS) have rarely been studied applying a systematic approach. Our aim was to define the... 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,...
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StartPage	6359
SubjectTerms	Comorbidity Hemorrhage Ischemia Medical treatment Medicine Medicine & Public Health Mortality Multivariate analysis Neurology Neuroradiology Neurosciences Neurosurgery Original Original Article Patients Psychiatry Risk factors Stroke Vasculitis
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Title	Rare stroke mechanisms in 4154 consecutive patients: causes, predictors, treatment, and outcomes
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