22. European Stroke Conference 288 Etiology of stroke and risk factors Aortic Atheroma and Ischemic Stroke Recurrence L.I. Pereira1, C. R. Fernandes2, M. Rodrigues3 Hospital Garcia de Orta, EPE, Almada, PORTUGAL1, Hospital Garcia de Orta, EPE, Almada, PORTUGAL2, Hospital Garcia de Orta, EPE, Almada, PORTUGAL3 Background Recurrent ischemic stroke (IS) is common in complex aortic atheroma. Transesopha-geal echocardiogram (TEE) is used to assess aortic plaques. Randomized studies on management are waited. We describe recurrence rate and risk factors in patients with/without aortic atheroma. Methods Retrospective observational study in patients admitted to a Neurology ward with IS or transient ischemic attack in 5 years. If TEE was done, clinical data, aortic atheroma, drugs and fol-low- up were recorded. We report rates and compare groups with odds ratio (OR) using logistic regression, recurrence risk by Kaplan-Meyer curves with Log Rank (LR) and Cox regression with Hazard Ratio (HR), along with 95% confidence intervals (95%CI). Results 337 of 1300 patients had TEE (25.9%; mean age 55.7 years; 62.9% male). 18.2% had com-plex plaques (CP) and 28.3% non-complex plaques (NCP). CP was key for anticoagulation (AC) on discharge (50.8% vs 14.9% if NCP vs 23.3% without plaques (WoP); p<0.001), even after adjust-ment for conditions needing AC (OR=5.0, 95%CI 2.4-10.6). Recurrence rate was 10.3% (lethality 1.3%) in 604.7 days of mean follow-up. No difference was found between risk factors of patients with/without recurrence. After 1 year of follow-up more new events were seen in aortic atheroma (7.1% if CP, 5.7% if NCP and 1.8% WoP, LR p=0.097). The dif-ference between groups with and WoP is significant at 1 year (6.3% vs 1.8%, LR p=0.013), but fades with time until end of follow-up. Adjusting for antithrombotic therapy, 1 year recurrence risk (HR) is 3.54 (95%CI 1.04-12.09) for CP vs NCP+WoP and 6.23 (95%CI 1.36-28.44) vs WOP. Higher recurrence happens in CP patients without AC (12%), followed by NCP+WoP without AC (4%), CP with AC (3.2%) and NCP+WoP with AC (0%), LR p=0.082. Conclusion Complex aortic atheroma has higher 1 year recurrence risk, mainly without AC. As 2/3 of the events in CP happened in the first year, the risk is non-significant afterwards. AC protection may diminish with time. 438 © 2013 S. Karger AG, Basel Scientific Programme 289 Etiology of stroke and risk factors The prevalence of migraine in an in-patient stroke population. M. Lantz1, K. Kostulas2, E. Waldenlind3, C. Sjöstrand4 Dept of Clinical Neuroscience, Karolinska Institutet. Karolinska University Hospital, Stock-holm, SWEDEN1, Dept of Clinical Neuroscience, Karolinska Institutet. Karolinska University Hospital, Stockholm, SWEDEN2, Dept of Clinical Neuroscience, Karolinska Institutet. Karolinska University Hospital, Stockholm, SWEDEN3, Dept of Clinical Neuroscience, Karolinska Institutet. Karolinska University Hospital, Stockholm, SWEDEN4 Introduction: Multiple studies have shown an increased risk for ischemic stroke in migraineurs, es-pecially in patients with migraine with aura (MA). In this study we have investigated the prevalence of migraine headache, in an in-patient stroke population. Material and methods: Patients admitted to the stroke unit with a diagnosis of acute cerebrovascular disease between May and October 2009, were recruited and given a semi-structured questionnaire regarding demographic data and previous or on-going episodes of recurrent headache. Additional data regarding risk factors for cerebrovascular disease, investigations performed, blood tests and prevalence of patent foramen ovale (PFO) were collected for all patients responding to the question-naire. Results: Of 281 admitted patients, 234 received a questionnaire and 179 answers were collected resulting in a response frequency of 77%. Responders matched the initial cohort regarding distribu-tion of age, sex and type of stroke. Fifty-seven patients (31.8%) reported a history of episodes with recurrent headache; of these 36 cases (20.1%) fulfilled criteria for migraine diagnosis according to ICHD-2. Sixty-one percent of migraine patients had MA. Stroke patients with migraine headache were younger and with a female dominance. Presence of patent foramen ovale (PFO) in the cohort was low; 11.1%, although significantly in-creased in patients with migraine headache (p= 0.0065) compared to patients without migraine. There were no significant differences, between patients with and without migraine headache regard-ing other conventional risk factors. Conclusions: The prevalence of migraine was comparable to the general prevalence of migraine in the western civilizations. However, patients with migraine were more prone to have a MA than ex-pected. The increased prevalence of PFO in patients with migraine headache corresponds well to previous population studies.
Karger_ESC London_2013
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