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Embolic stroke of undetermined source

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https://www.readbyqxmd.com/read/29766772/rivaroxaban-for-stroke-prevention-after-embolic-stroke-of-undetermined-source
#1
Robert G Hart, Mukul Sharma, Hardi Mundl, Scott E Kasner, Shrikant I Bangdiwala, Scott D Berkowitz, Balakumar Swaminathan, Pablo Lavados, Yongjun Wang, Yilong Wang, Antonio Davalos, Nikolay Shamalov, Robert Mikulik, Luis Cunha, Arne Lindgren, Antonio Arauz, Wilfried Lang, Anna Czlonkowska, Jens Eckstein, Rubens J Gagliardi, Pierre Amarenco, Sebastian F Ameriso, Turgut Tatlisumak, Roland Veltkamp, Graeme J Hankey, Danilo Toni, Daniel Bereczki, Shinichiro Uchiyama, George Ntaios, Byung-Woo Yoon, Raf Brouns, Matthias Endres, Keith W Muir, Natan Bornstein, Serefnur Ozturk, Martin J O'Donnell, Matthys M De Vries Basson, Guillaume Pare, Calin Pater, Bodo Kirsch, Patrick Sheridan, Gary Peters, Jeffrey I Weitz, W Frank Peacock, Ashkan Shoamanesh, Oscar R Benavente, Campbell Joyner, Ellison Themeles, Stuart J Connolly
Background Embolic strokes of undetermined source represent 20% of ischemic strokes and are associated with a high rate of recurrence. Anticoagulant treatment with rivaroxaban, an oral factor Xa inhibitor, may result in a lower risk of recurrent stroke than aspirin. Methods We compared the efficacy and safety of rivaroxaban (at a daily dose of 15 mg) with aspirin (at a daily dose of 100 mg) for the prevention of recurrent stroke in patients with recent ischemic stroke that was presumed to be from cerebral embolism but without arterial stenosis, lacune, or an identified cardioembolic source...
May 16, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/29749592/-a-systematic-review-of-the-characteristics-and-prognosis-of-subjects-who-suffer-an-embolic-stroke-of-undetermined-source
#2
J Molina-Seguin, A B Vena, L Colas-Campas, I Benalbdelhak, F Purroy
INTRODUCTION: The concept of embolic stroke of undetermined source (ESUS) has recently appeared to better characterise patients with cryptogenic stroke. PATIENTS AND METHODS: A systematic review of studies published since 2014 was performed to evaluate the epidemiology, clinical features and prognosis of patients with ESUS and their proportion among patients with cryptogenic stroke. RESULTS: Ten studies were identified with a total of 14,810 patients...
May 16, 2018: Revista de Neurologia
https://www.readbyqxmd.com/read/29737498/management-of-embolic-stroke-of-undetermined-source-esus
#3
REVIEW
Tobias Geisler, Annerose Mengel, Ulf Ziemann, Sven Poli
According to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification, embolic stroke of undetermined source (ESUS) has refined the old definition of cryptogenic stroke. More sophisticated criteria and a well-defined diagnostic workup point out the embolic nature of this disease. Because ESUS is associated with a high stroke recurrence, a clear risk prediction and management is of utmost importance to improve prognosis. To date, standard pharmacotherapy consists of antiplatelet drugs and statins...
May 8, 2018: Drugs
https://www.readbyqxmd.com/read/29718528/established-and-potential-echocardiographic-markers-of-embolism-and-their-therapeutic-implications-in-patients-with-ischemic-stroke
#4
Paulina E Gąsiorek, Maciej Banach, Marek Maciejewski, Andrzej Głąbiński, Aleksandra Paduszyńska, Jacek Rysz, Agata Bielecka-Dąbrowa
Cardiogenic strokes comprised 11% of all strokes and 25% of ischemic strokes. An accurate identification of the cause of stroke is necessary in order to prepare an adequate preventive strategy. In this review the confirmed and potential causes of embolic strokes are presented, which can be detected in echocardiography in the context of present treatment guidelines and gaps in evidence. There remains a need for further studies assessing the meaning of potential cardiac sources of embolism and establishment of rules for optimal medical prevention (antiplatelet therapy [APT] vs...
May 2, 2018: Cardiology Journal
https://www.readbyqxmd.com/read/29609876/covert-atrial-fibrillation-and-atrial-high-rate-episodes-as-a-potential-cause-of-embolic-strokes-of-undetermined-source-their-detection-and-possible-management-strategy
#5
REVIEW
Hirofumi Tomita, Shingo Sasaki, Joji Hagii, Norifumi Metoki
Cryptogenic ischemic stroke, defined as stroke of undetermined etiology, accounts for 7-25% of all ischemic strokes. Stroke severity is reported to be less severe than cardioembolic stroke and similar to large-artery atherosclerosis. Because its etiology is believed to be mostly an embolic type, it is often called "embolic strokes of undetermined source" (ESUS). In patients with ESUS, it is of significant importance to seek an embolic source with intensive diagnostic assessment, which mostly originates from the heart...
March 30, 2018: Journal of Cardiology
https://www.readbyqxmd.com/read/29571754/carotid-intraplaque-hemorrhage-in-patients-with-embolic-stroke-of-undetermined-source
#6
Navneet Singh, Alan R Moody, Val Panzov, David J Gladstone
BACKGROUND: Many embolic strokes are of undetermined source (ESUS). Carotid artery intraplaque hemorrhage (IPH), an unstable component of atherosclerosis, may be an under-recognized etiology in patients with ESUS. We investigated the prevalence of carotid IPH detected noninvasively by magnetic resonance imaging (MRI). METHODS: This pilot study analyzed data from a prospective cohort of patients with a recent ESUS who underwent MRI for carotid IPH assessment. All patients had carotid artery stenosis of less than 50%...
March 20, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29569253/detection-and-management-of-atrial-fibrillation-after-cryptogenic-stroke-or-embolic-stroke-of-undetermined-source
#7
REVIEW
Tommaso Sanna, Paul D Ziegler, Filippo Crea
Cryptogenic stroke (CS) and embolic stroke of unknown source (ESUS) represent a major challenge to healthcare systems worldwide. Atrial fibrillation (AF) is commonly found after CS or ESUS. Independent of the mechanism of the index CS or ESUS, detection of AF in these patients offers the opportunity to reduce the risk of stroke recurrence by prescribing an anticoagulant instead of aspirin. The detection of AF may be pursued with different monitoring strategies. Comparison of monitoring strategies should take into account that AF detection rates reported in published studies, and then pooled in meta-analyses, are not only a function of the monitoring strategy itself, but also depend on patient-related, device-related, and study design-related factors...
March 22, 2018: Clinical Cardiology
https://www.readbyqxmd.com/read/29566416/beyond-stroke-prevention-in-atrial-fibrillation-exploring-further-unmet-needs-with-rivaroxaban
#8
C M Gibson, G J Hankey, T Nafee, R C Welsh
With improved life expectancy and the aging population, the global burden of atrial fibrillation (AF) continues to increase, and with AF comes an estimated fivefold increased risk of ischaemic stroke. Prophylactic anticoagulant therapy is more effective in reducing the risk of ischaemic stroke in AF patients than acetylsalicylic acid or dual-antiplatelet therapy combining ASA with clopidogrel. Non-vitamin K antagonist oral anticoagulants are the standard of care for stroke prevention in patients with non-valvular AF...
March 22, 2018: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/29556872/embolic-strokes-of-undetermined-source-in-a-cohort-of-polish-stroke-patients
#9
Jan Pawel Bembenek, Michal Adam Karlinski, Iwona Kurkowska-Jastrzebska, Anna Czlonkowska
We aimed to provide a descriptive analysis of embolic stroke of undetermined etiology (ESUS) population based on a long-term prospective stroke registry. We retrospectively analyzed data collected in a detailed registry regarding consecutive patients admitted for first-ever ischemic stroke (IS) between January 2001 and December 2015. We used Org 10172 in Acute Stroke Treatment classification supplemented with ESUS criteria proposed by the Cryptogenic Stroke/ESUS International Working Group. Within the ESUS group, we additionally compared patients ≤ 60 and > 60 years of age...
March 19, 2018: Neurological Sciences
https://www.readbyqxmd.com/read/29525076/characterization-of-patients-with-embolic-strokes-of-undetermined-source-in-the-navigate-esus-randomized-trial
#10
Scott E Kasner, Pablo Lavados, Mukul Sharma, Yongjun Wang, Yilong Wang, Antoni Dávalos, Nikolay Shamalov, Luis Cunha, Arne Lindgren, Robert Mikulik, Antonio Arauz, Wilfried Lang, Anna Czlonkowska, Jens Eckstein, Rubens Gagliardi, Pierre Amarenco, Sebastián F Ameriso, Turgut Tatlisumak, Roland Veltkamp, Graeme J Hankey, Danilo S Toni, Daniel Bereczki, Shinichiro Uchiyama, George Ntaios, Byung-Woo Yoon, Raf Brouns, M M DeVries Basson, Matthias Endres, Keith Muir, Natan Bornstein, Serefnur Ozturk, Martin O'Donnell, Hardi Mundl, Calin Pater, Jeffrey Weitz, W Frank Peacock, Balakumar Swaminathan, Bodo Kirsch, Scott D Berkowitz, Gary Peters, Guillaume Pare, Ellison Themeles, Ashkan Shoamanesh, Stuart J Connolly, Robert G Hart
BACKGROUND: The New Approach Rivaroxaban Inhibition of Factor Xa in a Global Trial vs. ASA to Prevent Embolism in Embolic Stroke of Undetermined Source (NAVIGATE-ESUS) trial is a randomized phase-III trial comparing rivaroxaban versus aspirin in patients with recent ESUS. AIMS: We aimed to describe the baseline characteristics of this large ESUS cohort to explore relationships among key subgroups. METHODS: We enrolled 7213 patients at 459 sites in 31 countries...
June 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29449280/prediction-of-the-multisegment-clot-sign-on-dynamic-ct-angiography-of-cardioembolic-stroke
#11
Z Chen, F Shi, M Zhang, X Gong, L Lin, M Lou
BACKGROUND AND PURPOSE: The multisegment clot sign has been observed at the site of large-artery occlusion in patients with acute ischemic stroke. This study aimed to assess its occurrence rate and relationship with stroke etiologies in patients with acute intracranial large-artery occlusion. MATERIALS AND METHODS: We included consecutive patients with acute ischemic stroke who had acute intracranial large-artery occlusion and underwent perfusion CT within 8 hours after stroke onset...
April 2018: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/29398537/left-atrial-appendage-morphology-and-embolic-stroke-of-undetermined-source-a-cross-sectional-multicenter-pilot-study
#12
Shadi Yaghi, Andrew D Chang, Peter Hung, Brian Mac Grory, Scott Collins, Ajay Gupta, Jacques Reynolds, Caitlin B Finn, Morgan Hemendinger, Shawna M Cutting, Ryan A McTaggart, Mahesh Jayaraman, Audrey Leasure, Lauren Sansing, Nikhil Panda, Christopher Song, Antony Chu, Alexander Merkler, Gino Gialdini, Kevin N Sheth, Hooman Kamel, Mitchell S V Elkind, David Greer, Karen Furie, Michael Atalay
BACKGROUND: The left atrial appendage (LAA) is the main source of thrombus in atrial fibrillation, and there is an association between non-chicken wing (NCW) LAA morphology and stroke. We hypothesized that the prevalence of NCW LAA morphology would be higher among patients with cardioembolic (CE) stroke and embolic stroke of undetermined source (ESUS) than among those with noncardioembolic stroke (NCS). METHODS: This multicenter retrospective pilot study included consecutive patients with ischemic stroke from 3 comprehensive stroke centers who previously underwent a qualifying chest computed tomography (CT) to assess LAA morphology...
February 2, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29371436/relationship-between-visceral-infarction-and-ischemic-stroke-subtype
#13
Caitlin Finn, Peter Hung, Praneil Patel, Ajay Gupta, Hooman Kamel
BACKGROUND AND PURPOSE: Most cryptogenic strokes are thought to have an embolic source. We sought to determine whether cryptogenic strokes are associated with visceral infarcts, which are usually embolic. METHODS: Among patients prospectively enrolled in CAESAR (Cornell Acute Stroke Academic Registry), we selected those with a contrast-enhanced abdominal computed tomographic scan within 1 year of admission. Our exposure variable was adjudicated stroke subtype per the Trial of ORG 10172 in Acute Stroke Treatment classification...
March 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29218790/embolic-strokes-of-undetermined-source-in-young-adults-baseline-characteristics-and-long-term-outcome
#14
N Martinez-Majander, K Aarnio, J Pirinen, T Lumikari, T Nieminen, M Lehto, J Sinisalo, M Kaste, T Tatlisumak, J Putaala
BACKGROUND AND PURPOSE: Embolic strokes of undetermined source (ESUS) are a recent entity, not yet thoroughly investigated in young stroke patients. The clinical characteristics and long-term risks of vascular events and all-cause mortality between young-onset ESUS and other aetiological subgroups were compared. METHODS: Patients with ESUS were identified amongst the 1008 patients aged 15-49 years with first-ever ischaemic stroke in Helsinki Young Stroke Registry, and primary end-points were defined as recurrent stroke, composite vascular events and all-cause mortality...
March 2018: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/29187386/high-incidence-of-atrial-fibrillation-after-embolic-stroke-of-undetermined-source-in-posterior-cerebral-artery-territory
#15
Hisaki Makimoto, Muhammed Kurt, Michael Gliem, John-Ih Lee, Jan Schmidt, Patrick Müller, Lukas Clasen, Christoph Brinkmeyer, Dong-In Shin, Sebastian Jander, Malte Kelm, Alexander Fürnkranz
BACKGROUND: Subclinical atrial fibrillation is one possible cause of embolic stroke of undetermined source (ESUS). It remains to be elucidated if a specific infarction site has a predictive value for detecting subclinical atrial fibrillation. We aimed to investigate the predictive value of infarction site in patients with ESUS for the detection of atrial tachyarrhythmia (AT) using an insertable cardiac monitor. METHODS AND RESULTS: Consecutive 146 patients (84 men; aged 62±12 years) underwent insertable cardiac monitor implantation after diagnosis of ESUS...
November 29, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29174290/associations-of-mitral-and-aortic-valve-calcifications-with-complex-aortic-atheroma-in-patients-with-embolic-stroke-of-undetermined-source
#16
Kentaro Ishizuka, Takao Hoshino, Kyomi Ashihara, Kenji Mruyama, Sono Toi, Satoko Mizuno, Yuka Shirai, Nobuhisa Hagiwara, Kazuo Kitagawa
BACKGROUND: This study investigated the associations of mitral and aortic valve calcification with complex aortic atheroma among patients with embolic stroke of undetermined source. METHODS: We included 52 consecutive patients (mean age 58.1 years; 75.0% male) with embolic stroke of undetermined source. Mitral annular calcification, aortic annular calcification, and aortic valve sclerosis were assessed by transthoracic echocardiography. Complex aortic atheroma was assessed by transesophageal echocardiography and was defined as plaque protruding greater than or equal to 4 mm into the lumen or with ulcerated or mobile components...
March 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29111018/embolic-stroke-of-undetermined-source-the-role-of-the-nonstenotic-carotid-plaque
#17
Zachary Bulwa, Ajay Gupta
Cryptogenic stroke, or stroke of undetermined cause, presents a remarkably challenging dilemma for the treating physician as there are limited therapeutic options to prevent recurrence. Roughly one third of transient ischemic attacks (TIAs) and ischemic strokes are classified as cryptogenic, with an even greater proportion in young patients. While classification systems have been successfully used in trials to refine therapeutic approaches specific to subtype, there has been little progress made in secondary prevention of cryptogenic stroke...
November 15, 2017: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/29111002/free-fatty-acid-as-a-determinant-of-ischemic-lesion-volume-in-nonarterial-origin-embolic-stroke
#18
Jong-Won Chung, Woo-Keun Seo, Gyeong-Moon Kim, Chin-Sang Chung, Kwang Ho Lee, Oh Young Bang
GOALS: This study aimed to determine whether the plasma levels of free fatty acid (FFA) are associated with ischemic lesion characteristics in nonarterial-origin embolic stroke. MATERIALS AND METHODS: We prospectively recruited 254 patients with acute cerebral infarction caused by cardioembolic stroke (CES, n=121) or with embolic stroke of undetermined source (ESUS, n=133). Plasma levels of FFA were measured during the acute stage (median of 2days after stroke onset)...
November 15, 2017: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/28939703/association-between-troponin-levels-and-embolic-stroke-of-undetermined-source
#19
Alexander E Merkler, Gino Gialdini, Santosh B Murthy, Setareh Salehi Omran, Antonio Moya, Michael P Lerario, Ji Chong, Peter M Okin, Jonathan W Weinsaft, Monika M Safford, Matthew E Fink, Babak B Navi, Costantino Iadecola, Hooman Kamel
BACKGROUND: Our aim was to determine whether patients with embolic strokes of undetermined source (ESUS) have higher rates of elevated troponin than patients with noncardioembolic strokes. METHODS AND RESULTS: CAESAR (The Cornell Acute Stroke Academic Registry) prospectively enrolled all adults with acute stroke from 2011 to 2014. Two neurologists used standard definitions to retrospectively ascertain the etiology of stroke, with a third resolving disagreements...
September 22, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28862284/detection-of-atrial-fibrillation-in-patients-with-embolic-stroke-of-undetermined-source-by-prolonged-monitoring-with-implantable-loop-recorders
#20
Carsten Israel, Alkisti Kitsiou, Malik Kalyani, Sameera Deelawar, Lucy Ekosso Ejangue, Andreas Rogalewski, Christoph Hagemeister, Jens Minnerup, Wolf-Rüdiger Schäbitz
Recently, the clinical entity embolic stroke of undetermined source (ESUS) has been defined for patients with ischemic strokes, where neither a cardioembolic nor a non-cardiac source can be detected. These patients may suffer from asymptomatic atrial fibrillation (AF), terminating spontaneously and thus eluding detection. Implantable loop recorders (ILR) with automatic AF detection algorithms can detect short-lasting, subclinical AF. The aim of this study was to prospectively assess and predict AF detection in patients with ESUS using ILR with daily remote interrogation...
October 5, 2017: Thrombosis and Haemostasis
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