Evaluation of Cryptogenic Stroke With Advanced Diagnostic Techniques

Bang, Oh Young; Ovbiagele, Bruce; Kim, Jong Seung

doi:10.1161/strokeaha.113.003720

Cited by 89 publications

(82 citation statements)

References 88 publications

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“…Recent studies have chosen different criteria for stroke subtype definition 5,22 . These new criteria, combined with advanced diagnostic techniques, could help reducing the cryptogenic stroke observed in UND subtype 23 . In addition, not all of the patients in the present study were submitted to Holter monitoring and/or transesophageal echocardiography.…”

Section: Discussionmentioning

confidence: 99%

Incidence and mortality of ischemic stroke subtypes in Joinville, Brazil: a population-based study

Lange

Cabral

Moro

et al. 2015

Arq. Neuro-Psiquiatr.

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Previous population-based studies reported the incidence and mortality of ischemic stroke (IS) subtypes in different settings, most of them on the White population from high-income countries 1,2,3,4,5,6,7,8 . In Latin America, there is only one study, which was conducted in a Spanish and Mestizo population in Iquique, Chile 9. As far as we know, no previous study has reported IS subtypes rates among predominantly White people from Latin America.The crude annual incidence rate of IS in Brazil range from 62 to 92 per 100,000 inhabitants with a mixed pattern of cardiovascular risk, characterized by high prevalence of ischemic heart disease, dyslipidemia, hypertension and diabetes 10,11 . Determining the incidence, mortality and risk factors among IS subtypes may help to improve the public health actions and reduce the IS disease burden 12,13 . ABstrAct Aims: To measure the incidence and mortality rates of ischemic stroke (IS) subtypes in Joinville, Brazil. Methods: All first-ever IS patients that occurred in Joinville from January 2005 to December 2006 were identified. The IS subtypes were classified by the TOAST criteria, and the patients were followed-up for one year after IS onset. Results: The age-adjusted incidence per 100,000 inhabitants was 26 (17-39) for large-artery atherosclerosis (LAA), 17 (11-27) for cardioembolic (CE), 29 (20-41) for small vessel occlusion (SVO), 2 (0.6-7) for stroke of other determined etiology (OTH) and 30 (20-43) for stroke of undetermined etiology (UND). The 1-year mortality rate per 100,000 inhabitants was 5 (2-11) for LAA, 6 (3-13) for CE, 1 (0.1-6) for SVO, 0.2 (0-0.9) for OTH and 9 (4-17) for UND. Conclusion: In the population of Joinville, the incidences of IS subtypes were similar to those found in other populations. These findings highlight the importance of better detection and control of atherosclerotic risk factors.

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Section: Discussionmentioning

confidence: 99%

Incidence and mortality of ischemic stroke subtypes in Joinville, Brazil: a population-based study

Lange

Cabral

Moro

et al. 2015

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

show abstract

“…4,5 The reported prevalence of cryptogenic IS varies with the completeness and timing of diagnostic evaluation. 7 Earlier studies may have lacked uniform criteria for minimum diagnostic work-up or have not employed standardised diagnostic schemes. They may not have classified patients with low-or uncertain-risk sources of cardioembolism in the cryptogenic group.…”

Section: Introductionmentioning

confidence: 99%

Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Triggers, Causes, and Outcome (SECRETO): Rationale and design

Putaala

Martinez‐Majander

Saeed

et al. 2017

European Stroke Journal

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Background: Worldwide, about 1.3 million annual ischaemic strokes (IS) occur in adults aged <50 years. Of these early-onset strokes, up to 50% can be regarded as cryptogenic or associated with conditions with poorly documented causality like patent foramen ovale and coagulopathies. Key hypotheses/aims: (1) Investigate transient triggers and clinical/sub-clinical chronic risk factors associated with cryptogenic IS in the young; (2) use cardiac imaging methods exceeding state-of-the-art to reveal novel sources for embolism; (3) search for covert thrombosis and haemostasis abnormalities; (4) discover new disease pathways using next-generation sequencing and RNA gene expression studies; (5) determine patient prognosis by use of phenotypic and genetic data; and (6) adapt systems medicine approach to investigate complex risk-factor interactions. Design: Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Etiology, Triggers, and Outcome (SECRETO; NCT01934725) is a prospective multi-centre case-control study enrolling patients aged 18-49 years hospitalised due to first-ever imaging-proven IS of undetermined etiology. Patients are examined according to a standardised protocol and followed up for 10 years. Patients are 1:1 age-and sex-matched to stroke-free controls. Key study elements include centralised reading of echocardiography, electrocardiography, and neurovascular imaging, as well as blood samples for genetic, gene-expression, thrombosis and haemostasis and biomarker analysis. We aim to have 600 patientcontrol pairs enrolled by the end of 2018. Summary: SECRETO is aiming to establish novel mechanisms and prognosis of cryptogenic IS in the young and will provide new directions for therapy development for these patients. First results are anticipated in 2019.

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“…23 Patients with ESUS show distinct clinicoradiological features depending on the underlying causes: aortic arch atheroma, PFO, and paroxysmal atrial fibrillation. 24 Other authors and we have shown that patients with PFO had healthy vascular risk factor profiles and displayed posterior circulation involvement compared to patients with aortic arch atheroma or paroxysmal atrial fibrillation. 25 One brain single-photon emission computed tomography study showed that during the Valsalva maneuver the rate of blood flow in the posterior circulation was higher than that in the anterior circulation, which could be a possible explanation for the posterior predominance of paradoxical embolism.…”

Section: Diagnosis Of Patent Foramen Ovalementioning

confidence: 46%

A Case Report of Integrative Treatment with Conventional and Korean Medicine Applied to a Patient with Cerebral Infarction Due to Presumed Paradoxical Embolism Through a Patent Foramen Ovale

김¹,

옥²,

양³

et al. 2016

J Int Korean Med

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Patent foramen ovale (PFO) is growing in clinical interest because of a renewed focus on embolic stroke of undetermined source (ESUS), the PFO attributable fraction (the 10-point Risk of Paradoxical Embolism score), technical advances in PFO diagnosis, and the emergence of endovascular device closure as a treatment option. However, recent randomized controlled trials of the management of patients with ESUS and PFO failed to demonstrate the superiority of closure over medical treatment. The mechanisms of stroke other than paradoxical embolism may be important in patients with ESUS and PFO. This paper reviews the current understanding of the pathophysiology of stroke and therapeutic options in patients with PFO and ESUS.

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Evaluation of Cryptogenic Stroke With Advanced Diagnostic Techniques

Cited by 89 publications

References 88 publications

Incidence and mortality of ischemic stroke subtypes in Joinville, Brazil: a population-based study

Incidence and mortality of ischemic stroke subtypes in Joinville, Brazil: a population-based study

Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Triggers, Causes, and Outcome (SECRETO): Rationale and design

A Case Report of Integrative Treatment with Conventional and Korean Medicine Applied to a Patient with Cerebral Infarction Due to Presumed Paradoxical Embolism Through a Patent Foramen Ovale

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