Abstract
BackgroundIncidence of recurrent stroke is highest within 30 days after the initial ischemic stroke (IS) or TIA, but knowledge about early recurrence is lacking. We aimed to identify etiological groups with highest risk of early recurrence and assess how the TOAST classification identified index stroke etiology.MethodsMedical records of 1874 IS and TIA patients in the Bergen NORSTROKE registry were retrospectively reviewed for identification of recurrent IS or TIA within 30 days after index IS or TIA. Stroke etiology was determined by review of electronical medical journals. Logistic regression was used to calculate odds ratios (OR) for 30‐day recurrence.ResultsThirty‐three patients (1.8%) were readmitted with recurrent IS or TIA within 30 days after index stroke. By using TOAST, 12 patients were initially classified with stroke of unknown etiology (SUE). Etiologies behind recurrent IS or TIA were after the recurrent episode identified as extracranial large artery atherosclerosis (LAA) in 14 patients (42.4%), intracranial arterial pathology in seven patients (21.2%), active malignancy in six patients (18.2%), and cardio embolism in four patients (12.1%). Small vessel occlusion and SUE were the causes in one patient each. Logistic regression showed that patients with stroke of other determined etiology (SOE) and LAA had increased risk of 30‐day recurrence (OR = 9.72, 95% CI 1.84–51.3, p < 0.01 and OR = 4.36, 95% CI 2.01–9.47, p < 0.01, respectively).ConclusionPatients with LAA and SOE had increased risk of recurrent IS or TIA within 30 days. TOAST was inadequate at identifying exact etiologies behind recurrent stroke at index event.
Highlights
The purpose of diagnostic evaluation of acute stroke is identification of the causal etiology behind it, in order to reduce the risk of further strokes with appropriate secondary prevention
We found that 1.8% of our patients was readmitted with a recurrent ischemic stroke (IS) or transient ischemic attack (TIA) within 30 days
There is scant information on stroke recur‐ rence in Norway, but our rate is low compared to many large inter‐ national incidence studies (Bravata, Ho, Meehan, Brass, & Concato, 2007; Lovett et al, 2004; Sacco et al, 1994; Smith, Frytak, Liou, & Finch, 2005)
Summary
The purpose of diagnostic evaluation of acute stroke is identification of the causal etiology behind it, in order to reduce the risk of further strokes with appropriate secondary prevention. Many large studies on recurrent stroke incidence have excluded events. Most recurrent IS is of the same type as the index episode, except for lacunar IS, which seems especially true for early recurrence (Jones, Sen, Lakshminarayan, & Rosamond, 2013; Yamamoto & Bogousslavsky, 1998) This impli‐ cates that patients with the highest risk of early recurrence may not obtain a specific etiology and not receive the most effective secondary prevention. We aimed to identify etiological groups with highest risk of early recurrence and assess how the TOAST classification identified index stroke etiology. Logistic regres‐ sion showed that patients with stroke of other determined etiology (SOE) and LAA had increased risk of 30‐day recurrence (OR = 9.72, 95% CI 1.84–51.3, p < 0.01 and OR = 4.36, 95% CI 2.01–9.47, p < 0.01, respectively). TOAST was inadequate at identifying exact etiologies behind recur‐ rent stroke at index event
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