Kaul Subhash, Alladi Suvarna, Jabeen Shaik A, Bandaru V C S S Rao, Ankem Usharani, Mekala Shailaja, Naik G S
Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India.
Ann Indian Acad Neurol. 2018 Jul-Sep;21(3):209-213. doi: 10.4103/aian.AIAN_86_18.
Limited data regarding stroke subtypes exist from South Asian countries. The aim of the study was to determine the pattern of ischemic stroke subtypes and their associated risk factors, in a 10-year long hospital-based registry in the South Indian city of Hyderabad.
The Hyderabad stroke registry systematically collected clinical, radiological, and laboratory data of fully investigated consecutive stroke patients and studied pattern of ischemic stroke subtypes and their risk factor association.
The cohort comprised of 2642 patients: 2072 (78.4%) were ischemic and 570 (21.6%) were hemorrhagic strokes. In the ischemic stroke cohort, the mean age was 54.1 years and 1622 (78.3%) were men. The most common ischemic stroke subtype was large artery atherosclerosis (LAA) comprising 37.6% ( = 779), followed by small vessel occlusion comprising 19.9% ( = 413) and cardioembolism 11% ( = 228). Stroke of other determined etiologies constituted 4.2% ( = 86) and stroke of undetermined etiology was observed in 27.3%. Among patients with LAA, 610 (78.3%) patients had intracranial and 169 (21.7%) had extracranial disease as the underlying mechanism. Risk factor profile demonstrated that hyperlipidemia was significantly associated with LAA and ischemic heart disease with cardioembolic strokes.
The study reveals a distinct pattern of ischemic stroke subtypes in the Indian context that has overlapping features of registries from West and East Asian countries. Both large artery and small vessel diseases are substantially represented with a predominance of intracranial atherosclerosis. The study results have significant implications for developing preventive and management strategies for stroke care and research in India.
南亚国家关于卒中亚型的数据有限。本研究的目的是在印度南部城市海得拉巴一个长达10年的基于医院的登记系统中，确定缺血性卒中亚型的模式及其相关危险因素。
海得拉巴卒中登记系统系统收集了经过全面调查的连续性卒中患者的临床、放射学和实验室数据，并研究了缺血性卒中亚型的模式及其危险因素关联。
该队列包括2642例患者：2072例（78.4%）为缺血性卒中，570例（21.6%）为出血性卒中。在缺血性卒中队列中，平均年龄为54.1岁，1622例（78.3%）为男性。最常见的缺血性卒中亚型是大动脉粥样硬化（LAA），占37.6%（n = 779），其次是小血管闭塞，占19.9%（n = 413），心源性栓塞占11%（n = 228）。其他已确定病因的卒中占4.2%（n = 86），病因未明的卒中占27.3%。在LAA患者中，610例（78.3%）患者的潜在机制为颅内疾病，169例（21.7%）为颅外疾病。危险因素分析表明，高脂血症与LAA显著相关，缺血性心脏病与心源性栓塞性卒中显著相关。
该研究揭示了印度背景下缺血性卒中亚型的独特模式，具有来自西亚和东亚国家登记系统的重叠特征。大动脉和小血管疾病均占相当比例，颅内动脉粥样硬化占主导。该研究结果对制定印度卒中护理和研究的预防及管理策略具有重要意义。
