Stroke of Other Determined Etiology

Results From the Nationwide Multicenter Stroke Registry

Hyunsoo Kim, MD; Joon-Tae Kim, MD, PhD; Ji Sung Lee, PhD; Beom Joon Kim, MD, PhD; Jihoon Kang, MD, PhD; Keon-Joo Lee, MD, PhD; Jong-Moo Park, MD, PhD; Kyusik Kang, MD, PhD; Soo Joo Lee, MD, PhD; Jae Guk Kim, MD; Jae-Kwan Cha, MD, PhD; Dae-Hyun Kim, MD, PhD; Tai Hwan Park, MD, PhD; Kyung Bok Lee, MD, PhD; Jun Lee, MD, PhD; Keun-Sik Hong, MD, PhD; Yong-Jin Cho, MD, PhD; Hong-Kyun Park, MD; Byung-Chul Lee, MD, PhD; Kyung-Ho Yu, MD, PhD; Mi Sun Oh, MD, PhD; Dong-Eog Kim, MD, PhD; Wi-Sun Ryu, MD; Jay Chol Choi, MD, PhD; Jee-Hyun Kwon, MD, PhD; Wook-Joo Kim, MD, PhD; Dong-Ick Shin, MD, PhD; Kyu Sun Yum, MD, PhD; Sung Il Sohn, MD, PhD; Jeong-Ho Hong, MD, PhD; Sang-Hwa Lee, MD, PhD; Man-Seok Park, MD, PhD; Kang-Ho Choi, MD, PhD; Juneyoung Lee, PhD; Hee-Joon Bae, MD, PhD

Disclosures

Stroke. 2022;53(8):2597-2606. 

In This Article

Abstract and Introduction

Abstract

Background: Stroke of other determined etiology (OE) includes patients with an uncommon cause of stroke. We described the general characteristics, management, and outcomes of stroke in OE and its subgroups.

Methods: This study is a retrospective analysis of a prospective, multicenter, nationwide registry, the Clinical Research Center for Stroke-Korea-National Institutes of Health registry. We classified OE strokes into 10 subgroups according to the literature and their properties. Each OE subgroup was compared according to clinical characteristics, sex, age strata, lesion locations, and management. Moreover, 1-year composites of stroke and all-cause mortality were investigated according to the OE subgroups.

Results: In total, 2119 patients with ischemic stroke with OE types (mean age, 55.6±16.2 years; male, 58%) were analyzed. In the Clinical Research Center for Stroke-Korea-National Institutes of Health registry, patients with OE accounted for 2.8% of all patients with stroke. The most common subtypes were arterial dissection (39.1%), cancer-related coagulopathy (17.3%), and intrinsic diseases of the arterial wall (16.7%). Overall, strokes of OE were more common in men than in women (58% versus 42%). Arterial dissection, intrinsic diseases of the arterial wall and stroke associated with migraine and drugs were more likely to occur at a young age, while disorders of platelets and the hemostatic system, cancer-related coagulopathy, infectious diseases, and hypoperfusion syndromes were more frequent at an old age. The composite of stroke and all-cause mortality within 1 year most frequently occurred in cancer-related coagulopathy, with an event rate of 71.8%, but least frequently occurred in stroke associated with migraine and drugs and arterial dissection, with event rates of 0% and 7.2%, respectively.

Conclusions: This study presents the different characteristics, demographic findings, lesion locations, and outcomes of OE and its subtypes. It is characterized by a high proportion of arterial dissection, high mortality risk in cancer-related coagulopathy and an increasing annual frequency of cancer-related coagulopathy in patients with stroke of OE.

Graphic Abstract: A graphic abstract is available for this article.

Introduction

Stroke of other determined etiology (OE) includes patients who have an uncommon cause of stroke (such as arterial dissections and hypercoagulable states) but who cannot be categorized as having large artery atherosclerosis, small vessel occlusion, or cardioembolism.[1] The proportion of OE is relatively low, with ranges from ≈ 2% to 9%, compared with other stroke subcategories.[2–6] In the Acute Stroke Registry and Analysis of Lausanne, OE subtypes were found in 9.2% of patients (n=160) from the analysis of 1633 patients with stroke.[3] Among 2894 patients with ischemic stroke, 5% of patients (n=174) exhibited unusual stroke mechanisms in the Barcelona Stroke registry.[5] However, because of the small numbers of OE subtypes in previous studies, there is a paucity of information on the general characteristics of stroke of OE, as well as the proportions and outcomes of OE subgroups.

Uncommon causes of stroke have been studied individually because of the diversity of the causes. Therefore, research on the general features of OE and its subgroups will be of great value for improving the understanding of stroke of OE, which can be used as a starting point for clinical research for uncommon strokes.

In the current study, we aimed to present a descriptive analysis of the epidemiological, clinical, imaging, and outcome data of overall stroke in OE and its subgroups from a nationwide, multicenter stroke registry.

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