Etiologies, mechanisms, and risk factors of ischemic stroke in a Asian adult cohort

Objectives: Risk factors and causes of acute ischemic stroke (AIS) are more diverse in young adults, and traditional stroke classifications maybe inadequate. Precise char-acterisation of AIS is important for guiding management and prognostication. We describe stroke subtypes, risk factors and etiologies for AIS in a young Asian adult population. Materials and methods: Young AIS patients aged 18-50 years admitted to two comprehensive stroke centres from 2020-2022 were included. Stroke etiologies and risk factors were adjudicated using Trial of Org 10172 in Acute Stroke Treat-ment (TOAST) and International Pediatric Stroke Study (IPSS) risk factors. Potential embolic sources (PES) were identified in a subgroup with embolic stroke of undeter-mined source (ESUS). These were compared across sex, ethnicities and age groups (18-39 years versus 40-50 years). Results: A total of 276 AIS patients were included, with mean age 43 +/- 5.7 years and 70.3% male. Median duration of follow-up was 5 months (IQR: 3-10). The most common TOAST subtypes were small-vessel disease (32.6%) and undetermined etiology (24.6%). IPSS risk factors were identified in 95% of all patients and 90% with undetermined etiology. IPSS risk factors included ath-erosclerosis (59.5%), cardiac disorders (18.7%), prothrombotic states (12.4%) and arteriopathy (7.7%). In this cohort, 20.3% had ESUS, of which 73.2% had at least one PES, which increased to 84.2% in those <40 years old. Conclusions: Young adults have diverse risk factors and causes of AIS. IPSS risk factors and ESUS-PES con-struct are comprehensive classification systems that may better reflect heteroge-neous risk factors and etiologies in young stroke patients.

Automated summary

This study describes the stroke subtypes, risk factors, and etiologies for acute ischemic stroke (AIS) in a young Asian adult population. The results show that young adults with AIS have diverse risk factors and causes. The International Pediatric Stroke Study (IPSS) risk factors and Embolic Stroke of Undetermined Source Potential Embolic Sources (ESUS-PES) construct may better reflect the heterogeneous risk factors and etiologies in young stroke patients.