London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 441 294 Etiology of stroke and risk factors Leukoaraiosis is a possible risk factor for future stroke and vascular events in small vessel transient ischemic attack D.-I. Chang1, D. Lee2, S.H. Heo3 Kyung Hee University College of Medicine, Seoul, SOUTH KOREA1, Kyung Hee University College of Medicine, Seoul, SOUTH KOREA2, Kyung Hee University College of Medicine, Seoul, SOUTH KOREA3 Background: Clinical decisions remain uncertain when patients only present a subjective symp-tom suspicious for transient ischemic attack (TIA) without relevant atherosclerosis or cardiombolic sources. Many parts of these clinical situations could belong to small vessel transient ischemic at-tack syndrome (SVTIAS). Since neuro-imaging technologies have become more developed, we are now able to define SVTIAS more precisely. In this study, we attempted to identify neuro-imaging predictors of vascular events after SVTIAS. Methods: Study subjects were extracted from our prospectively-designed stroke registry from Sep-tember 2003 to February 2011. We checked the traditional vascular risk factors, clinical characteris-tics and brain magnetic resonance imaging (MRI) findings silent brain infarcts (SIs), leukoaraiosis (LA) severity, cerebral microbleeds (CMBs) and acute ischemic lesion on diffusion-weighted imag-ing (DWI). Subsequent stroke, TIA or acute coronary syndrome after index TIA was recorded as a clinical outcome. TIA cases with clear causative atherosclerotic lesions were selected to a group for the further statistical comparison with SVTIAS in order to find a more distinctive characteristic of SVTIAS. Results: We determined that 70 patients had SVTIAS and 59 patients were classified as having transient ischemic attack syndrome due to large vessel atherosclerosis (LVTIAS). Among the SV-TIAS group, five patients had stroke or TIA and three patients had acute coronary syndrome. Only LA severity showed a statistically significant hazard ratio to predict stroke and TIA recurrences in SVTIAS group (Hazard ratio: 9.419, 95% Confidence interval: 1.059–84.845, p=0.044). LA sever-ity showed statistical significances after adjustment by age and gender or other MRI findings (SIs, CMBs, and DWI). Age and hypertension were the most contributable vascular risk factors of the LA severity in both groups. Conclusion: Our findings suggest that LA severity is a possible risk factor for future strokes and TIA in patients with SVTIAS. 295 Etiology of stroke and risk factors Prevalence, determinants and implications of the aortic atherosclerosis in acute stroke C. Fernandes1, L. Pereira2, M. Rodrigues3 Hospital Garcia de Orta, Almada, PORTUGAL1, Hospital Garcia de Orta, Almada, PORTU-GAL2, Hospital Garcia de Orta, Almada, PORTUGAL3 Background: The association of aortic atheroma and stroke is well established. We aim to deter-mine the prevalence of aortic atheroma in patients with acute ischemic stroke (AIS), associated risk factors and compare subgroups. Methods: Observational retrospective study in patients admitted to Neurology ward with AIS in 5 years. In those with transesophageal echocardiogram (TEE) demo-graphics, vascular risk factors, aortic atheroma, and lesion pattern were collected. Atheroma was simple (<4mm) or complex (>=4mm, ulceration, mobile component). We present descriptive and inferential statistics with t-test, ANOVA, chi-square and logistic regression with odds ratio (OR), 95% confidence intervals (95%CI). Results: In 1300 subjects, 337 had TEE (25.9%), mean age 55.7 years, 62.9% men. Hyperlipidemia was present in 68.8%, 63.5% had hypertension, 20.5% diabetes, 9.8% atrial fibrillation (AF), 38.6% smokers. Simple and complex atheroma identified in 28.3% and 18.2%. Subjects with atheroma were older (p<0.001), more men had complex atheroma (p=0.032). Risk factor prevalence in patients with complex, simple and no atheroma: smoking 75.9%, 52.2%, 45.9% (p<0.001); diabetes 31.9%, 29.0%, 39.1% (p=0.002); hypertension 22.9%, 31.8%, 45.3% (p<0.001); hyperlipidemia 20.8%, 30.7%, 48.5% (p=0.019); AF 12.1%, 39.4%, 48.5% (p=0.285). On multivariate analysis, age≥55years (OR=7.1; 95%CI 3.2-15.6) and smoking (OR=4.7; 95%CI 2.1-10.3) remained associated with complex atheroma, age to simple atheroma (OR=3.5; 95%CI 2.0-6.2%). Stroke in patients with atheroma was more frequently territorial (p=0.012) and cortical (p=0.002). Posterior circulation was more affected (59.1%; p=0.001), even after adjusting for verte-bral artery disease, smoking, age and AF exclusion (OR=3.0; 95%CI 1.3-6.9). Conclusion: The as-sociation of aortic atheroma with posterior circulation stroke, without vertebral artery disease or AF, suggests an embolic mechanism. In this setting, investigation for aortic atheroma is warranted.
Karger_ESC London_2013
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