Evolution of Ischemic Stroke Subtypes in Hong Kong

Five time points, i.e. 2004, 2006, 2008, 2010, 2012, 2014, 2016, 2018 are selected for analysis. All consecutive stroke patients included in the Prince of Wales Hospital stroke registry will be recruited. Patients will be stratified according to their stroke subtypes with reference to the TOAST classification (1), which includes large artery disease, cardioembolism, small vessel occlusion, other determined causes, undetermined cause or incomplete investigations. Stroke etiology is determined by stroke neurologists with reference to the history, physical signs, imaging including carotid duplex, transcranial doppler, computer tomography (CT), CT angiogram, magnetic resonance imaging (MRI), MR angiogram, electrocardiography (ECG) and echocardiography. Interobserver variability for stroke mechanism determination will be evaluated. Pre-defined demographic data including age, gender, smoking status, vascular risk factors including hyperlipidaemia, hypertension, diabetes, prior stroke or TIA, etc. will be retrieved from the stroke registry. The investigator will also compare the use of antiplatelet agents, anticoagulants, lipid-lowering agents, specific antihypertensives in the Shatin territory across the 15-year period using the CDARS.