Abstract Details

Title Etiologic Stroke Subtypes in the NINDS Stroke Genetics Network Study

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S32 - (-)

Poster/Presentation
Number 001

Objective

Background Reproducible data on stroke subtypes in large multicenter datasets based on well-referenced and evidence-based criteria are scarce. We sought to determine stroke subtypes in a large international consortium of ischemic stroke studies which aims to identify the genetic basis of ischemic stroke subtypes.

Design/Methods We used the Causative Classification of Stroke System (CCS) to identify etiologic stroke subtypes. CCS is a web-based, automated, and evidence-based algorithm that identifies the most likely stroke etiology by harmonizing clinical stroke features and data from the stroke work-up. Adjudicators at each participating site trained and certified in CCS identified etiologic subtypes based on chart reviews. Ten percent of all adjudicated cases were readjudicated by members of the Phenotype Core or independent site adjudicators.

Results CCS subtypes were determined in 15,720 cases from 11 US and 11 European sites. There was a good agreement between adjudicators and readjudicators (kappa = 0.76, 95% CI: 0.73-0.79). The most common stroke subtype was cardio-aortic embolism (31%), followed by large artery atherosclerosis (17%), small artery occlusion (11%), undetermined causes (12%), and other uncommon causes (6%). A subtype could not be assigned in 23% of the cases because of insufficient evaluation. The overall distribution of etiologic categories varied with respect to age (<50 vs. ?50 years), sex, race, study site, cohort type (hospital-based vs. population-based), and brain imaging used (CT vs. MRI) (p<0.001 for all variables).

Conclusions Ischemic stroke subtypes could be determined with high reliability in collaborative studies that include investigators with different expertise and background, institutions with different stroke evaluation protocols and geographic location, and patient populations with different epidemiological characteristics.

Authors/Disclosures
Hakan AY, MD (Takeda) PRESENTER	Dr. AY has received personal compensation for serving as an employee of Takeda.
Ethem Murat Arsava, MD	Dr. Arsava has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Nutricia. Dr. Arsava has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abbott. Dr. Arsava has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Fresenius. Dr. Arsava has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Daichi-Sankyo. Dr. Arsava has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Pfizer. Dr. Arsava has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bayer. Dr. Arsava has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Nutricia. Dr. Arsava has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Abbott. Dr. Arsava has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Sanofi. Dr. Arsava has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Pfizer. Dr. Arsava has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Daichi Sankyo. Dr. Arsava has received research support from TUBITAK.
Robert D. Brown, Jr., MD, MPH, FAAN (Mayo Clinic)	Dr. Brown has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Craig H Neilsen Foundation. The institution of Dr. Brown has received research support from National Institutes of Health/NINDS. Dr. Brown has received publishing royalties from a publication relating to health care.
	No disclosure on file
Steven J. Kittner, MD, MPH (Dept of Neurology)	The institution of Dr. Kittner has received research support from NINDS.
	No disclosure on file
Jonathan Rosand, MD (Massachusetts General Hospital)	Dr. Rosand has received personal compensation for serving as an employee of Massachusetts General Hospital. Dr. Rosand has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eli Lilly and Co. Dr. Rosand has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. Dr. Rosand has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for National Football League. The institution of Dr. Rosand has received research support from NIH. The institution of Dr. Rosand has received research support from American Heart Association. Dr. Rosand has received personal compensation in the range of $0-$499 for serving as a Peer reviewer with National Institutes of Health. Dr. Rosand has a non-compensated relationship as a Trustee with Columbia University that is relevant to AAN interests or activities.
Tatjana Rundek, MD, PhD	The institution of Dr. Rundek has received research support from NIH.
Bradford B. Worrall, MD, MSc, FAAN (University Of Virginia Health System)	The institution of Dr. Worrall has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AAN. The institution of Dr. Worrall has received research support from NIH.
Daniel Woo, MD, FAAN (University at Buffalo)	The institution of Dr. Woo has received research support from NIH.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Raji P. Grewal, MD, FAAN	No disclosure on file
Ralph L. Sacco, MD, MS, FAHA	Dr. Sacco has received personal compensation in the range of $100,000-$499,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association. The institution of Dr. Sacco has received research support from NIH, NINDS, NCATS, NIMHD. The institution of Dr. Sacco has received research support from FL Department of Health. Dr. Sacco has received research support from University of Washington, Seattle. Dr. Sacco has received publishing royalties from a publication relating to health care.
John Cole, MD (UMD SOM)	Dr. Cole has nothing to disclose.
Agnieszka Slowik, MD, FAAN (Jagiellonian University)	Dr. Slowik has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Boehringer, . Dr. Slowik has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Slowik has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Vincent Thijs, MD	Dr. Thijs has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Medtronic. Dr. Thijs has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Allergan. Dr. Thijs has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for BMS. Dr. Thijs has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Pfizer. Dr. Thijs has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Boehringer Ingelheim.
Reinhold Schmidt, MD	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Jin M. Lee, MD, PhD (Washington University School of Medicine)	No disclosure on file
	No disclosure on file
	No disclosure on file
Myriam Fornage	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
James F. Meschia, MD, FAAN (Mayo Clinic)	The institution of Dr. Meschia has received research support from NINDS. The institution of Dr. Meschia has received research support from NINDS.

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