Embolic Stroke of Undetermined Source

Hart, Robert G.; Catanese, Luciana; Perera, Kanjana; Ntaios, George; Connolly, Stuart J.

doi:10.1161/strokeaha.116.016414

Cited by 453 publications

(225 citation statements)

References 45 publications

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“…The included patients also presented with relatively mild symptoms (mean NIHSS score 4.3 points). Our cohort's NIHSS score is, however, comparable to that described in ESUS patients (Hart et al, 2017).…”

Section: Discussionsupporting

confidence: 61%

“…However, pathogenesis remains unknown in 25%-30% of all ischemic strokes despite complete diagnostic evaluation, leading to diagnosis of cryptogenic stroke. A more sophisticated classification of cryptogenic strokes with an embolic neuroimaging pattern-embolic stroke of undetermined source (ESUS)-was recently introduced and defined as a nonlacunar stroke without a major cardioembolic source nor major arterial occlusions or other causes for the stroke (Hart, Catanese, Perera, Ntaios, & Connolly, 2017). Patients in the ESUS subgroup suffer from a high stroke recurrence risk, comparable to those with AF and other known high-risk sources of embolism (Putaala et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

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Continuous 4‐week ECG monitoring with adhesive electrodes reveals AF in patients with recent embolic stroke of undetermined source

Lumikari

Putaala

Kerola

et al. 2019

Noninvasive Electrocardiol

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BackgroundAtrial fibrillation (AF) frequently escapes routine stroke workup due to its unpredictable and often asymptomatic nature, leaving a significant portion of patients at high risk of recurrent stroke. Recent trials emphasized continuous electrocardiogram (ECG) monitoring in the detection of occult AF. We screened AF in patients meeting the embolic stroke of unknown source (ESUS) criteria using an external miniaturized recorder with an adhesive electrode.MethodsPatients aged ≥50 with recent ESUS were prospectively screened and assigned to wear a 1‐lead ECG device capable to record continuous ECG for up to 4 weeks. Electrodes were replaced every 3–4 days. Primary outcome was proportion of patients completing at least 80% of monitoring. Secondary outcome measures included incidence of AF and initiation of oral anticoagulation therapy after AF detection.ResultsFifty‐seven patients were monitored (mean age 64.5 ± 8.2 years, median delay from stroke to the start of monitoring 8 days, IQR 4–44). Of these, 51 patients (89.5%) completed at least 80% of the desired monitoring period. We detected AF ≥30 s in seven patients (12.3%), all of whom initiated anticoagulation therapy. Atrial fibrillation was revealed in six patients (85.7%) within the first week of monitoring. Compared to patients without AF, patients with AF were older (70.6 ± 5.1 vs. 63.6 ± 8.3 years, p < 0.011) and more obese (body mass index 30.0 ± 3.4 vs. 26.6 ± 4.6, p < 0.039).ConclusionsProlonged ECG monitoring with an external device using adhesive electrodes is feasible in ESUS patients, since nine out of ten patients used the device appropriately and AF was detected in one out of eight patients.

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Section: Discussionsupporting

confidence: 61%

Section: Introductionmentioning

confidence: 99%

Continuous 4‐week ECG monitoring with adhesive electrodes reveals AF in patients with recent embolic stroke of undetermined source

Lumikari

Putaala

Kerola

et al. 2019

Noninvasive Electrocardiol

View full text Add to dashboard Cite

show abstract

“…We classified all ischaemic strokes based on the TOAST criteria as large vessel, cardioembolic, small vessel, cryptogenic and other determined aetiology . Within the cryptogenic strokes for patients 60 years and under, we sub‐classified embolic stroke of undetermined source, which denotes non‐lacunar cryptogenic strokes in patients where embolism is the most likely stroke mechanism …”

Section: Methodsmentioning

confidence: 99%

Prevalence and risk factors of ischaemic stroke in the young: a regional Australian perspective

Siriratnam

Godfrey

O'Connor

et al. 2020

Internal Medicine Journal

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Background There is no universally accepted age cut‐off for defining young strokes. Aims We aimed to determine, based on the profile of young stroke patients in our regional centre, an appropriate age cut‐off for young strokes. Methods A retrospective analysis of all ischaemic stroke patients admitted to our centre from 2015 to 2017. We identified 391 ischaemic stroke patients; 30 patients between the ages of ≤50, 40 between 51–60 inclusive and 321 ≥ 61 years of age. We collected data on demographic profiles, risk factors and stroke classification using the Trial of Org 10 172 in Acute Stroke Treatment criteria. Results We found significant differences between the ≤50 and ≥61 age groups for most of the risk factors and similarities between the 51–60 inclusive and ≥ 61 age groups. At least one of the six risk factors assessed in the study was present in 86.7% of the youngest group, 97.5% of the intermediate age group and 97.2% in the oldest group. In terms of the mechanisms of stroke, the youngest and oldest age groups in our study differed in the prevalence of cryptogenic, cardioembolic and other causes of stroke. The middle and older age groups had similar mechanisms of stroke. Conclusions The prevalence of vascular risk factors and mechanisms of stroke likewise differed significantly across age groups. This study suggests that 50 years is an appropriate age cut‐off for defining young strokes and reinforces the importance of primary prevention in all age groups.

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“…[1][2][3] Patent foramen ovale (PFO), a frequent finding in the general population, 4,5 is considered a possible underlying mechanism in a proportion of embolic stroke of undetermined source patients, 6 and its closure has been suggested as an efficacious intervention on top of medical treatment. Until recently, only 3 randomized controlled trials had tested this hypothesis yielding inconclusive results.…”

mentioning

confidence: 99%

Closure of Patent Foramen Ovale Versus Medical Therapy in Patients With Cryptogenic Stroke or Transient Ischemic Attack

Ntaios

Papavasileiou

Sagris

et al. 2018

Stroke

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Embolic Stroke of Undetermined Source

Cited by 453 publications

References 45 publications

Continuous 4‐week ECG monitoring with adhesive electrodes reveals AF in patients with recent embolic stroke of undetermined source

Continuous 4‐week ECG monitoring with adhesive electrodes reveals AF in patients with recent embolic stroke of undetermined source

Prevalence and risk factors of ischaemic stroke in the young: a regional Australian perspective

Closure of Patent Foramen Ovale Versus Medical Therapy in Patients With Cryptogenic Stroke or Transient Ischemic Attack

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