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Heart Disease/Stroke

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Stroke type influences chance of recurrence, survival, and poststroke functioning

Stroke recurrence and survival rates are well documented, but it is less clear what the rates are for patients with different types of stroke. A recent study that was supported in part by the Agency for Healthcare Research and Quality (Stroke Patient Outcomes Research Team, PORT, contract 290-91-0028), focused on the differences among patients who had strokes without bleeding in or around the brain. For example, stroke patients whose embolism originated in the heart (cardioembolic) had the poorest survival, patients whose stroke was caused by intracranial atherosclerosis with narrowing or stenosis had higher recurrence rates, and patients with lacunae (small areas of cerebral infarction) had better poststroke functional status than patients with other types of nonhemorrhagic (ischemic) stroke.

These findings are based on a study of functional outcomes of residents of Rochester, MN, who had a first ischemic stroke between 1985 and 1989. The researchers compared how survival and recurrence rates varied among patients with common stroke subtypes. A first ischemic stroke occurred in 454 Rochester residents during the study period; 80 percent were hospitalized, and 75 percent were evaluated by a neurologist. Subtypes of stroke were atherosclerotic (16 percent), cardioembolic (29 percent), lacunar (16 percent), uncertain type (36 percent), and other or unusual causes (3 percent).

Lacunar stroke patients had milder maximal neurological deficits at the time of stroke and better poststroke functional scores compared with patients who had other types of stroke. Lacunar stroke patients also had the best functional outcomes, with more than 80 percent having minimal or no impairment 1 year after the stroke. Cardioembolic stroke patients had poorer prestroke functional status, more severe neurological deficits at the time of stroke, and poorer functional outcomes compared with other subtypes. Cardioembolic stroke patients also were nearly four times as likely to die within 30 days after stroke than patients with ATH and 2.5 times more likely to die in the next 5 years. Twenty-five patients had recurrent stroke within 30 days; 13 of these patients had large-vessel atherosclerosis with narrowing (stenosis) of the artery as the first stroke subtype.

See "Ischemic stroke subtypes: A population-based study of functional outcome, survival, and recurrence," by George W. Petty, M.D., Robert D. Brown Jr., M.D., Jack P. Whisnant, M.D., and others, in Stroke 31, pp. 1062-1068, 2000.

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