Abstract 2360: Aortogenic Stoke: Comparative Analysis With Lacunar And Atherothrombotic Infarction
[Background & aims] Detailed characteristics of aortogenic stroke (AO) have remained unclear so far. Our aim was to determine clinical characteristics of AO in Japanese stroke patients in comparison with lacunar infarction (LA) and atherothrombotic infarction (AT), two subtypes affected different sizes of cerebral vessels.
[Methods] From June 2007 to October 2010, 3228 consecutive patients were hospitalized for acute ischemic stroke and were enrolled in the Fukuoka Stroke Registry. AO was defined as follows; embolic stroke of which source was complicated plaque lesion in the aortic arch depicted by transesophageal echocardiography or 3-dimension computed tomography and no other potential embolic sources existed. We collected the data regarding clinical background, risk factors, prescription, laboratory data, severity and outcome of AO patients, and compared with those of the patients with LA and AT.
[Results] We identified 137 (4.2%) AO patients, 658 (20.4%) AT patients, and 753 (23.3%) LA patients. Among the three patient groups, AO patients were the oldest (74.5±0.93 y o, p<0.01) and had family history of stroke (45.1%, p<0.01) and past history of cardiovascular disease (33.1%, p<0.01) the most frequently. Both AO and AT patients were prescribed more with antiplatelet (40.9%, p<0.01) and lipid-lowering agent (24.8%, p= 0.045) than LA patients before stroke onset. In the acute phase, alteplase (5.1%, p<0.01) and unfractionated heparin (80.3%, p<0.01) were used more frequently in AO patients than in LA and AT patients. AO patients showed the highest in-hospital recurrence rate (6.6% in AO, 6.5% in AT and 0.8% in LA, respectively); however, the NIHSS score of AO patients was the lowest during the whole length of hospitalization (IQR 0-4 points on admission, p<0.01 and IQR 0-2 points on discharge, p<0.01). At discharge, warfarin (13.9%, p< 0.01) and aspirin (51.8%, p<0.01) were chosen for prevention of recurrence in AO patients. Stroke recurrence rates within first one year in AO, AT and LA were 2.2%, 4.7% and 1.9%, respectively. Frequency of good prognosis (modified Rankin scale 0-2) at discharge and at one year from onset was more than 80% in both AO and LA patients, whereas that in AT patients was significantly low (55.2% at discharge and 62.8% at one year).
[Conclusion] AO patients were older and had more cardiovascular risk factors and were prescribed more medications than those with LA and AT. In spite of high in-hospital recurrence rate and large size of the affected vessels, AO patients showed few long-term recurrence and relatively favorable outcome.
- © 2012 by American Heart Association, Inc.