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(Stroke. 2001;32:1285.)
© 2001 American Heart Association, Inc.

Original Contributions

Greater Cincinnati/Northern Kentucky Stroke Study

Volume of First-Ever Ischemic Stroke Among Blacks in a Population-Based Study

Brett Kissela, MD; Joseph Broderick, MD; Daniel Woo, MD; Rashmi Kothari, MD; Rosie Miller, RN; Jane Khoury, MS; Thomas Brott, MD; Arthur Pancioli, MD; Edward Jauch, MD; James Gebel, MD; Rakesh Shukla, PhD; Kathleen Alwell, RN Thomas Tomsick, MD

From the Department of Neurology (B.K., J.B., D.W., R.M., K.A.), the Department of Emergency Medicine (A.P., E.J.), and the Department of Environmental Health (J.K.), University of Cincinnati (Ohio); the Borgess Research Institute (R.K.), Kalamazoo, Mich; the Department of Neurology (T.B.), Mayo Clinic, Jacksonville, Fla; and the Department of Neurology (J.G.), University of Pittsburgh (Pa).

Correspondence to Brett Kissela, MD, University of Cincinnati, Department of Neurology, 231 Albert Sabin Way, ML 0525, Cincinnati, OH 45267–0525. E-mail kisselbm{at}uc.edu

Background and Purpose—The volume of ischemic stroke on CT scans has been studied in a standardized fashion in acute stroke therapy trials with median volumes between 10.5 to 55 cm³. The volume of first-ever ischemic stroke in the population is not known.

Methods—The first phase of the population-based Greater Cincinnati/Northern Kentucky Stroke Study identified all ischemic strokes occurring in blacks in the greater Cincinnati region between January and June of 1993. The patients in this phase of the study who had a first-ever ischemic clinical stroke were identified, and the volume of ischemic stroke was measured.

Results—There were 257 verified clinical cases of ischemic stroke, of which 181 had a first-ever ischemic infarct. Imaging was available for 150 of these patients, and 79 had an infarct on the CT or MRI study that was definitely or possibly related to the clinical symptoms. For these patients, volumetric measurements were performed by means of the modified ellipsoid method. The median volume of first-ever ischemic stroke for the 79 patients was 2.5 cm³ (interquartile range, 0.5 to 8.8 cm³). There was a significant relation between location of lesion and infarct size (P<0.001) and between volume and mechanism of stroke (P=0.001).

Conclusions—The volume of first-ever ischemic stroke among blacks in our population-based study is smaller than has been previously reported in acute stroke therapy trials. The large proportion of small, mild strokes in blacks may be an important reason for the low percentage of patients who meet the inclusion criteria for tissue plasminogen activator. Further study is necessary to see if these results are generalizable to a multiracial population.

Editorial Comment

The Greater Cincinnati/Northern Kentucky Stroke Study: Volume of First-Ever Ischemic Stroke Among Black Americans in a Population-Based Study

Edgar J. Kenton, III, MD, Guest Editor>

Chair, Advisory Committee, American Stroke Association, Division of Neurology, Main Line/Jefferson Health System, Philadelphia, Pennsylvania

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