Ischemic Stroke Risk Factors and Subtypes

Ischaemic stroke arises from interruption of cerebral blood flow and comprises several subtypes distinguished by underlying mechanisms. The Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification defines major categories: large-artery atherosclerosis, small vessel occlusion (often lacunar infarction), cardioembolism and strokes of undetermined aetiology. Non-modifiable risk factors include age, sex and genetic predisposition, while modifiable factors encompass hypertension, diabetes mellitus, dyslipidaemia, smoking and atrial fibrillation. Hypertension accelerates small-vessel arteriopathy, predisposing to lacunar events, whereas elevated low-density lipoprotein cholesterol drives atherosclerotic plaques in large arteries. Cardioembolic strokes often follow atrial fibrillation or valvular heart disease. Emerging evidence highlights the role of inflammatory biomarkers and machine-learning derived phenotypes in refining risk stratification. Understanding the interplay of these factors underpins targeted prevention and secondary care across diverse populations.

Research from Nature Portfolio

A large cohort study of patients with small artery occlusion evaluated recurrence rates and associated factors over 3, 12 and 36 months. Overall recurrence rose from 3.1 % at 3 months to 36.5 % at 36 months. Male sex, advancing age and initial stroke severity independently increased the risk of early recurrence. Elevated C-reactive protein predicted recurrence at 12 months, while hypertension, atrial fibrillation and obesity emerged as key determinants of later recurrence. Notably, moderate alcohol consumption was linked to a lower 12-month recurrence risk. These findings underscore the necessity of rigorous control of vascular risk factors and inflammatory status in patients with small vessel disease.

Ischemic Stroke Risk Factors and Subtypes publication trend

The graph below shows the total number of articles in ischemic stroke risk factors and subtypes across all publications each year (not limited to Nature Index journals).

Technical terms

Ischaemic stroke: Brain infarction due to occlusion of cerebral arteries.

TOAST classification: A system to categorise ischaemic stroke subtypes by presumed cause.

Lacunar infarct: Small cerebral infarction (<15 mm) from occlusion of a penetrating artery.

Large-artery atherosclerosis: Stroke caused by plaque build-up and stenosis in major extracranial or intracranial arteries.

Cardioembolism: Stroke resulting from emboli originating in the heart, often in atrial fibrillation.

Small artery occlusion: Stroke subtype due to disease of small penetrating arterioles, often linked to hypertension.

References

1. A population-based study exploring phenotypic clusters and clinical outcomes in stroke using unsupervised machine learning approach. PLOS Digital Health (2023).
2. Comparison of Risk Factor between Lacunar Stroke and Large Artery Atherosclerosis Stroke: A Cross-Sectional Study in China. PLOS ONE (2016).
3. Recurrence Rate and Relevant Associated Factors of Stroke among Patients with Small Artery Occlusion in Northern China. Scientific Reports (2019).
4. Epidemiology, Risk Factors, and Predictors of Disability in a Cohort of Jordanian Patients with the First Ischemic Stroke. Stroke Research and Treatment (2020).