The mean age of ESUS patients (averaging 65 years) may reflect incomplete diagnostic investigation of older patients with stroke that permit the diagnosis of ESUS.41 With this caveat, the picture of ESUS patients that emerged is of relatively young (compared with atrial fibrillation-associated stroke) patients with mild strokes and with lower frequencies of conventional vascular risk factors compared with non-ESUS patients with ischemic stroke. Mais uma “siglinha” para se decorar… Guardem: É um dos Hot Topics de 2014. Multidetector computed tomography angiography to detect the cause of multiple brain infarctions. Embolic strokes of undetermined source: Prevalence and patient features in the ESUS Global Registry. The American Heart Association is qualified 501(c)(3) tax-exempt Ischemic stroke in patients with cancer: is it different from usual strokes? One-fifth of ischemic strokes are embolic strokes of undetermined source (ESUS). It is unclear whether brief episodes of atrial fibrillation detected weeks or months after ESUS are relevant to stroke cause or identify patients who benefit from anticoagulation. Recurrent stroke during follow-up averaged 4.5% per year (Table 4), but this estimate is based on patient cohorts dating back to 199213 and limited by the retrospective design of available studies. 9–22 Rothwell et al 23 showed that plaque surface irregularity on angiography is strongly associated with an increase in ipsilateral stroke risk irrespective of the … ‡Permanent or paroxysmal atrial fibrillation, sustained atrial flutter, intracardiac thrombus, prosthetic cardiac valve, atrial myxoma or other cardiac tumors, mitral stenosis, recent (<4 weeks) myocardial infarction, left ventricular ejection fraction <30%, valvular vegetations, or infective endocarditis. Patients with ischemic stroke meeting criteria for ESUS were relatively young compared with other ischemic stroke subtypes and had, on average, minor strokes, consistent with small emboli. Noninvasive cardiac event monitoring to detect atrial fibrillation after ischemic stroke: a randomized, controlled trial. There is an important need to define better antithrombotic prophylaxis for this frequently occurring subtype of ischemic stroke. Dallas, TX 75231 Consequently, this estimate of stroke recurrence rate in ESUS patients may be an overestimate. We identified 12 studies that reported the frequency of ESUS as a fraction of all ischemic strokes, with prevalences ranging from 7% to 42% (Table 2). Cryptogenic stroke and underlying atrial fibrillation. https://doi.org/10.1161/STROKEAHA.116.016414, National Center One study reporting a highly selected ESUS cohort was not included,6 nor were 5 published case reports.7–11 Investigators of included studies were selectively contacted seeking additional data.12, Table 1. There is an important need to define better antithrombotic prophylaxis for this frequently occurring subtype of ischemic stroke. Interest in ESUS has been fueled, in part, by 3 ongoing randomized trials comparing nonvitamin K antagonist direct-acting oral anticoagulants with aspirin for secondary stroke prevention.2–4. Customer Service Eight studies reported patient features of 2045 ESUS patients (Table 3). Noninvasive cardiac event monitoring to detect atrial fibrillation after ischemic stroke: a randomized, controlled trial. Here, we report the results of a systematic review of published studies about ESUS and summarize additional recent information relevant to the ESUS construct. Journal of the American Heart Association, Circulation: Cardiovascular Interventions, https://clinicaltrials.gov/ct2/show/NCT02427126, Carotid Plaque With High-Risk Features in Embolic Stroke of Undetermined Source, External Performance of the HAVOC Score for the Prediction of New Incident Atrial Fibrillation, Atrial Cardiopathy and Nonstenosing Large Artery Plaque in Patients With Embolic Stroke of Undetermined Source, Embolic Stroke of Undetermined Source and Sleep Disorders, Embolic Stroke of Undetermined Source and Symptomatic Nonstenotic Carotid Disease, Etiologic Workup in Cases of Cryptogenic Stroke, Potential Embolic Sources and Outcomes in Embolic Stroke of Undetermined Source in the NAVIGATE-ESUS Trial, Prevalence of Ipsilateral Nonstenotic Carotid Plaques on Computed Tomography Angiography in Embolic Stroke of Undetermined Source, High-Sensitivity Cardiac Troponin T for Risk Stratification in Patients With Embolic Stroke of Undetermined Source, Frequency and Predictors of Major Bleeding in Patients With Embolic Strokes of Undetermined Source, Cost-Effectiveness of Extended Electrocardiogram Monitoring for Atrial Fibrillation After Stroke, Machine Learning Prediction of Stroke Mechanism in Embolic Strokes of Undetermined Source, Left Atrial Volume Index Is Associated With Cardioembolic Stroke and Atrial Fibrillation Detection After Embolic Stroke of Undetermined Source, Prevalence and Overlap of Potential Embolic Sources in Patients With Embolic Stroke of Undetermined Source, Efficacy and Safety of Rivaroxaban Versus Aspirin in Embolic Stroke of Undetermined Source and Carotid Atherosclerosis, Prevalence and Impact of Venous and Arterial Thromboembolism in Patients With Embolic Stroke of Undetermined Source With or Without Active Cancer, Antithrombotic Treatment in Cryptogenic Stroke Patients With Patent Foramen Ovale, Cancer-Related Ischemic Stroke Has a Distinct Blood mRNA Expression Profile, Aortic Arch Atherosclerosis in Patients With Embolic Stroke of Undetermined Source, Searching for Atrial Fibrillation Poststroke, The Case for Selective Patent Foramen Ovale Closure After Cryptogenic Stroke, Closure of Patent Foramen Ovale Versus Medical Therapy in Patients With Cryptogenic Stroke or Transient Ischemic Attack, Updated Criteria for Population-Based Stroke and Transient Ischemic Attack Incidence Studies for the 21st Century, Left Atrial Appendage Thrombus and Embolic Stroke, Renal Function and Risk Stratification of Patients With Embolic Stroke of Undetermined Source, Detection of Left Ventricular Thrombus by Cardiac Magnetic Resonance in Embolic Stroke of Undetermined Source, Embolic Stroke of Uncertain Source: An Entity Slowly Coming Into Focus, 1. 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