Determine the prevalence and location of large artery atherosclerosis (LAA) in the young stroke population.

Past the age of 35, the prevalence of LAA related strokes increases with accumulating cardiovascular risk factors (CVRFs). There is limited data regarding the location of LAA in stroke among young adults.

We conducted a retrospective review of stroke patients between 18 to 50 years of age presenting to our Young Stroke Center between April 2022 and August 2023. Data including demographics and medical history were collected, and stroke etiology was determined by a vascular neurologist. Risk factors for patients with LAA as their stoke etiology were compared to those for all non-LAA stroke etiologies. Analysis was performed with logistic regression adjusting for age, sex, and race.

Of 179 patients, 15 (8.4%) had LAA compared with 164 with non-LAA as their stroke etiology. Of all LAA related strokes, one was due to extracranial carotid stenosis, and 14 were due to intracranial atherosclerotic disease. There was a significant difference in age at time of stroke (42.9 ± 5.0 vs. 38.2 ± 8.0 years; OR [95% CI]: 1.11 [1.01-1.21]) between LAA and non-LAA groups, respectively. There was no significant difference in sex (66.7% vs. 62.8% female) and race (46.7% vs. 54.9% Black). A significantly larger proportion of patients with LAA-related stroke had baseline CVRFs including hypertension (80.0% vs. 44.5%; 5.0 [1.2-20.3]), dyslipidemia (66.7% vs. 31.7%; 4.3 [1.3-14.1]), and obesity (33.3% vs. 12.2%; 5.6 [1.5-20.7]). There was also a trend toward increased rates of smoking (40.0% vs. 20.7%; 2.82 [0.9-9.0]) and diabetes (26.7% vs. 18.9%; 1.3 [0.3-4.7]).

In the young stroke population, LAA accounts for a significant portion of strokes and is more likely due to intracranial disease rather than extracranial disease. Its association with traditional CVRFs reinforces the importance of early intervention for the prevention of stroke.