Abstract WP252: Secular Trends for Etiologies of Acute Ischemic Stroke in Young Adults

Abstract

Introduction: Because acute ischemic stroke (AIS) in young adults is not rare, understanding trends in etiology may help decisions about evaluation and secondary stroke prevention. This study describes probable causes of AIS in a cohort of young adults and identifies changes in etiologies and diagnostic studies compared to 20 years ago. Methods: We retrospectively reviewed all patients aged 15-45 admitted to our comprehensive stroke center between 1/2010-11/2016 with AIS. Diagnostic studies and stroke etiologies for each patient were reviewed. We then compared our results to a historic sample of young patients who presented to our center in 1977-1993 using univariate chi-squared comparison for each etiology. Results: We identified 333 young adults, 169 (50.8%) were women. The mean age was 36.4±7.1 years. Vessel imaging was performed in 305 (91.3%) cases vs. 68.9% in the historic sample. Of these, 247 (81.0%) had magnetic resonance angiography (MRA). Transthoracic echocardiography (TTE) was performed in 101 (30.3%) and transesophageal echocardiography (TEE) was performed in 171 (51.4%) cases compared to 67.1% who underwent TTE in the historic sample. Etiologic comparisons to the historic sample yielded significant decline in small vessel disease ( P = .029) and a major increase in stroke of other identified cause ( P = .024). Other TOAST etiologies illustrated in Figure 1. The most common etiology for stroke in our sample was arterial dissection 84 (25.2%), whereas this was found in only 6.0% of patients in the historic sample ( P< .001). Conclusions: Using the TOAST classification, the most common subtype in young adults was stroke of other identified cause; a rate that reflects a marked increase in the diagnosis of dissection. Despite advancement in diagnostic studies, cryptogenic stroke remains a common category in young adults.