Abstract WP276: Large Artery Atherosclerosis and Young Stroke

Abstract

Introduction: It is known that past the age of 35, the prevalence of large artery atherosclerosis (LAA) related strokes increases with a cardiovascular risk factor (CVRF) profile beginning to resemble that of elderly patients. However, LAA-related strokes still only account for <10% of all young strokes over the age of 35. Further, there is limited data regarding the location, intracranial or extracranial, of LAA in this patient population. Methods: We conducted a retrospective review of stroke patients between the ages of 18 to 50 years presenting to our Young Stroke Center between April 2022 through August 2023. For each case, data including basic demographics and medical history were collected, and stroke etiology was determined by a vascular neurologist. Patients with LAA as the stoke etiology were compared to all non-LAA stroke etiologies. The two groups were analyzed with respect to baseline demographics and CVRFs. Analysis was performed with logistic regression adjusting for age, sex, and race. Results: Of 179 patients in the registry, 15 patients had LAA compared with 164 patients with non-LAA as their stroke etiology. Only one patient had extracranial carotid stenosis, with the rest of the LAA patients having intracranial atherosclerotic disease. There was a significant difference in age at time of stroke (42.9 ± 5.0 vs. 38.2 ± 8.0 years; OR [95% CI]: 1.11 [1.01-1.21]) between LAA and non-LAA groups, respectively. There was no significant difference in sex (66.7% vs. 62.8% female) and race (46.7% vs. 54.9% Black). A significantly larger proportion of patients with LAA had baseline CVRFs including hypertension (80.0% vs. 44.5%; 5.0 [1.2-20.3]), dyslipidemia (66.7% vs. 31.7%; 4.3 [1.3-14.1]), and obesity (33.3% vs. 12.2%; 5.6 [1.5-20.7]). There was also a trend toward increased rates of smoking (40.0% vs. 20.7%; 2.82 [0.9-9.0]) and diabetes (26.7% vs. 18.9%; 1.3 [0.3-4.7]). Conclusion: In the young stroke population, stroke due to LAA is more likely due to intracranial disease rather than extracranial disease and is associated with traditional CVRFs including hypertension, dyslipidemia, and obesity. These findings reinforce the importance of early intervention of modifiable risk factors for primary prevention of stroke in the young.