medwireNews: Research shows that a substantial proportion of younger patients with stroke or transient ischemic attack (TIA) have atherosclerotic carotid stenosis and occlusions, highlighting the need for vascular risk management in this age group.
"This study illustrates that atherosclerosis of the extracranial and intracranial arteries is a major risk factor in younger stroke patients in Europe," write Bettina von Sarnowski (Ernst Moritz Arndt University, Greifswald, Germany) and colleagues in Neurology.
The study assessed stroke patients who were a subset of the large European, multicenter database of the Stroke in Young Fabry Patients 1 (sifap1) study, which enrolled patients who previously had an acute cerebrovascular event (CVE).
Examination of the extracranial vertebral artery and use of ultrasonography allowed researchers to assess the prevalence of carotid plaques, stenosis, and occlusions in 2187 TIA and ischemic stroke patients. Younger (18-44 years) and middle-aged (45-55 years) patients were stratified while cases of dissection, vasculitis, and mobile thrombus were excluded.
A large majority (76.6%) of the ischemic stroke patients with carotid artery disease had a CVE that was due to large-artery disease, the study found.
Of the patients with ischemic stroke, 8.9% had at least unilateral extracranial internal carotid artery stenosis of 50% or more, or occlusion; 81% of which were symptomatic. The proportion of patients in the older subgroup who had this form of atherosclerosis (11.0%) was almost as high as that reported for stroke patients who are even older, according to the study authors.
The study team was surprised to find carotid artery disease in 4.9% of the younger subgroup of patients - though it was significantly less prevalent than in the middle-aged subgroup.
Intracranial artery disease was even more common than extracranial carotid artery disease, affecting 13.9% of the stroke patients, and was found mainly in the middle cerebral artery.
While the study found that a majority of CVEs in younger and middle-aged patients did not stem from atherosclerosis, the authors highlight the "considerable minority" of younger patients with CVE who had significant large-artery atherosclerosis.
"Identification of at-risk individuals prior to their first CVE may allow for risk factor modification, with the potential to reduce stroke incidence in this population," the researchers conclude.
They suggest intracranial vascular imaging in younger stroke patients and large-scale cerebrovascular prevention campaigns aimed at young adults, and even at teenagers.