Factors associated with prognosis after small-vessel occlusion among young and middle-aged patients: a hospital-based follow-up study

ABSTRACT

Objective: Small-vessel occlusions are the most common causes of mild strokes and, in China, account for approximately 27.3% of ischemic stroke cases. However, the factors associated with short- and long-term outcomes appear contradictory. Thus, we assessed the factors related to outcomes 3 years after small-vessel occlusion among patients aged 18 to 55 years.

Methods: Between 2007 and 2014, we recruited patients who experienced small-vessel occlusion (according to Trial of Org 10,172 in Acute Stroke Treatment [TOAST] classification) aged 18 to 55 years and conducted a hospital-based follow-up study. The assessed outcomes were mortality, recurrence, and dependency within 3 years after the initial stroke. The outcome determinants were assessed using a multivariate logistic regression analysis.

Results: A total of 276 patients (men, 76.09%) with small-vessel occlusions were enrolled in this study. In addition, 85.1% of the patients had strokes between the ages of 45 and 55 years. The risk of recurrence within 3 years was higher for patients who had moderate strokes than for those who had mild events (relative risk [RR], 3.09; 95% confidence interval [CI], 1.14–8.34; P < 0.05). Further, the risk of dependency within 3 years was 2.61 times higher in obese patients than in non-obese patients (RR, 2.61; 95% CI, 1.00–6.79; P < 0.05). The risks of recurrence and dependency within 3 years increased by 17% and 18%, respectively, for each 1-unit increase in fasting plasma glucose levels (RR, 1.17; 95% CI, 1.05–1.30 and RR, 1.18; 95% CI, 1.06–1.32, respectively; both P < 0.05).

Conclusion: Our findings suggest that small-vessel occlusions cause the heaviest disease burden in patients aged 45 to 55 years. To reduce stroke recurrence, young and middle-aged patients with small-vessel occlusions should control their fasting plasma glucose levels and manage their weight.

KEYWORDS:

• Stroke
• small-vessel occlusion
• toast classification
• prognosis
• risk factors
• age

Acknowledgments

None stated

Declaration of funding

This study was partly supported by the Beijing Tianjin Hebei Basic Research Cooperation Project (contract: 19JCZDJC64600).

Declaration of financial/other relationships

The authors declare that there is no conflict of interest regarding this article. The contents of the paper and the opinions expressed within it are those of the authors, and it was the decision of the authors to submit the manuscript for publication.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Declaration of interest

No potential conflict of interest was reported by the author(s).