Objectives

Risk factors and causes of acute ischemic stroke (AIS) are more diverse in young adults, and traditional stroke classifications may be inadequate. Precise characterisation 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 Treatment (TOAST) and International Pediatric Stroke Study (IPSS) risk factors. Potential embolic sources (PES) were identified in a subgroup with embolic stroke of undetermined 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 atherosclerosis (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 construct are comprehensive classification systems that may better reflect heterogeneous risk factors and etiologies in young stroke patients.

中文翻译：

---

亚洲年轻成人队列中缺血性卒中的病因、机制和危险因素

目标

年轻人急性缺血性卒中（AIS）的危险因素和病因更加多样化，传统的卒中分类可能不够充分。AIS 的精确表征对于指导管理和预测非常重要。我们描述了亚洲年轻成年人群中 AIS 的中风亚型、危险因素和病因。

材料和方法

纳入 2020 年至 2022 年期间入住两个综合性卒中中心的 18-50 岁年轻 AIS 患者。中风病因和危险因素通过 Org 10172 急性中风治疗 (TOAST) 试验和国际儿童中风研究 (IPSS) 危险因素进行判定。在来源不明的栓塞性卒中 (ESUS) 亚组中确定了潜在的栓塞源 (PES)。这些数据在性别、种族和年龄组（18-39 岁与 40-50 岁）之间进行了比较。

结果

总共纳入 276 名 AIS 患者，平均年龄 43±5.7 岁，其中 70.3% 为男性。中位随访时间为 5 个月（IQR：3-10）。最常见的 TOAST 亚型是小血管疾病 (32.6%) 和病因不明 (24.6%)。95% 的患者中发现了 IPSS 危险因素，其中 90% 的病因尚未确定。IPSS的危险因素包括动脉粥样硬化（59.5%）、心脏疾病（18.7%）、血栓前状态（12.4%）和动脉病（7.7%）。在这一队列中，20.3% 的人患有 ESUS，其中 73.2% 的人至少患有一次 PES，在 40 岁以下的人群中这一比例增加到 84.2%。

结论

年轻人有多种 AIS 危险因素和原因。IPSS 危险因素和 ESUS-PES 构建是综合分类系统，可以更好地反映年轻卒中患者的异质危险因素和病因。