Aggressive Medical Care in Young Chinese Patients with Ischemic Stroke of Undetermined Etiology: A Retrospective Study

Abstract

Objectives: This study aimed to investigate the clinical and angiographic characteristics of ischemic stroke of undetermined etiology in young Chinese adults and to observe the effects of medication on their long-term outcomes. Methods: A total of 179 consecutive young patients with ischemic stroke of undetermined etiology were retrospectively analyzed for clinical and angiographic characteristics, laboratory tests, the choice of drug treatment, and follow-up outcomes. Any predictive power for recurrent stroke and new lesions or aggravated stenosis was analyzed. Results: 170 patients were clinically followed up for a median of 25 months (range, 4-92), and 65 patients with 114 lesions had angiographic follow-up for a median of 7 months. A total of 53 patients were enrolled in a routine medical management (RMM) group, and 117 were treated with corticosteroids plus RMM (aggressive medical management, AMM). Kaplan-Meier survival analysis revealed that differences in the 2-year cumulative stroke-free rate and in the 18-month cumulative worsening and/or new lesion-free rate between the RMM and AMM groups were significant (p < 0.05). Multivariate and Cox regression analyses revealed that the choice of drug therapy and erythrocyte sedimentation rate were associated with recurrent stroke, that AMM was independently associated with a decreased risk of worsening lesion, and that worsening lesion was the only independent predictor of recurrent stroke. Conclusion: Compared with RMM, AMM is more efficacious in the prevention of secondary ischemic stroke and progressive arterial lesions among young adults with ischemic stroke of undetermined etiology. i 2014 S. Karger AG, Basel