Embolic Stroke of Unknown Source Clinical Trials and Advances in Research

Johansen, Michelle C; Geocadin, Romergryko G.; Kamel, Hooman

doi:10.1002/ana.25825

Cited by 3 publications

(2 citation statements)

References 8 publications

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“…Given the challenges and limitations faced in NAVIGATE ESUS and RE-SPECT ESUS trials, and the frustration experienced by ESUS appearing strokes that recur at a rate of 4.0%-4.7% per year, 2,3 researchers have continued to explore alternative approaches and potential targets for stroke prevention in patients with ESUS. 6 The potential cardioembolic sources initially originally thought most likely to be causal in ESUS were covert AF and atrial cardiopathy, which includes left atrial (LA) atrial remodeling (e.g., enlargement, fibrosis), slow LA appendage flow, and subclinical damage to endothelial cells and cardiomyocytes. 7 Atrial dysfunction and remodeling, irrespective of the presence of AF, have been proven to be a substrate for LA thrombogenesis and embolism.…”

Section: Defining Atrial Cardiopathy As a Stroke Recurrence Preventio...mentioning

confidence: 99%

“…Given the challenges and limitations faced in NAVIGATE ESUS and RE-SPECT ESUS trials, and the frustration experienced by ESUS appearing strokes that recur at a rate of 4.0%–4.7% per year, 2,3 researchers have continued to explore alternative approaches and potential targets for stroke prevention in patients with ESUS. 6…”

Section: Defining Atrial Cardiopathy As a Stroke Recurrence Preventio...mentioning

confidence: 99%

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Embolic Stroke of Undetermined Source

Sposato,

Sur,

Katan

et al. 2024

Neurology

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Embolic strokes of undetermined source (ESUS) represent 9%-25% of all ischemic strokes. Based on the suspicion that a large proportion of cardioembolic sources remain undetected among embolic stroke of undetermined source patients, it has been hypothesized that a universal approach of anticoagulation would be better than aspirin for preventing recurrent strokes. However, 4 randomized controlled trials (RCTs), with different degrees of patient selection, failed to confirm this hypothesis. In parallel, several RCTs consistently demonstrated that prolonged cardiac monitoring increased atrial fibrillation detection and anticoagulation initiation compared with usual care in patients with ESUS, and later in individuals with ischemic stroke of known cause (e.g., large or small vessel disease). However, none of these trials or subsequent meta-analyses of all available RCTs have shown a reduction in stroke recurrence associated with the use of prolonged cardiac monitoring. In this article, we review the clinical and research implications of recent RCTs of antithrombotic therapy in patients with ESUS and in high-risk populations with and without stroke, with device-detected asymptomatic atrial fibrillation.

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Section: Defining Atrial Cardiopathy As a Stroke Recurrence Preventio...mentioning

confidence: 99%

Section: Defining Atrial Cardiopathy As a Stroke Recurrence Preventio...mentioning

confidence: 99%

Embolic Stroke of Undetermined Source

Sposato,

Sur,

Katan

et al. 2024

Neurology

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The Future of Ischemic Stroke Diagnosis and a Review of Underrecognized Ischemic Stroke Etiologies

Johansen

2023

Neurotherapeutics

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Causal relationship between metabolites and embolic stroke: based on Mendelian randomization and metabolomics

Hang,

Chen,

Ren

et al. 2024

Front. Neurol.

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PurposeThis research employed Mendelian randomization (MR) methods to explore whether metabolites are causally associated with embolic stroke of undetermined source (ESUS).MethodsGenome-Wide Association Study (GWAS) data regarding metabolites and ESUS were downloaded from the database. Metabolites were employed as exposure factors, ESUS served as the outcome variable, and single nucleotide polymorphisms (SNPs) exhibiting significant association with ESUS were chosen as instrumental variables. The causal association between exposure factor metabolites and the outcome variable ESUS was assessed using two methods: MR-Egger regression and inverse variance-weighted (IVW) analysis.ResultsA causal relationship was observed between X-11593--O-methylascorbate* and ESUS, indicating a protective factor. Moreover, a causal relationship was identified between cholesterol esters in large very-low-density lipoprotein (VLDL), cholesterol esters in medium low-density lipoprotein (LDL), concentration of medium LDL particles, phospholipids in medium LDL, phenylalanine, total cholesterol in small LDL, total lipids in medium LDL and ESUS, representing risk factor. Funnel plots exhibited a symmetrical distribution of SNPs, while pleiotropic tests (p > 0.05) and leave-one-out tests indicated that the results were relatively stable.ConclusionMetabolites are causally associated with ESUS. LDL and VLDL-related metabolites are identified as risk factors for ESUS.

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Embolic Stroke of Unknown Source Clinical Trials and Advances in Research

Cited by 3 publications

References 8 publications

Embolic Stroke of Undetermined Source

Embolic Stroke of Undetermined Source

The Future of Ischemic Stroke Diagnosis and a Review of Underrecognized Ischemic Stroke Etiologies

Causal relationship between metabolites and embolic stroke: based on Mendelian randomization and metabolomics

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