Embolic stroke of unknown source (ESUS) in young patients

Ladeira, Filipa; Barbosa, Raquel; Caetano, André; Mendonça, Marcelo; Viana-Baptista, Miguel

doi:10.1111/ijs.12596

Cited by 24 publications

(26 citation statements)

References 1 publication

(3 reference statements)

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“…Furthermore, the only report available thus far on younger ESUS patients included 100 patients aged 26À55 years with a mean age of 45 years. It suggested that up to four-fifths of young-onset cryptogenic IS would fulfil the criteria for ESUS and, again, 43% in that study were female [12]. In our study, a closely similar proportion (74%) of patients with stroke of UE potentially would have been classified as ESUS had they met all diagnostic criteria.…”

Section: Discussionsupporting

confidence: 67%

“…Most importantly, our study shows that, amongst ESUS patients, migraine (22%), atrial septal abnormalities (PFO or atrial septal aneurysm, 44%) and the use of COCs (15%) were significantly more common than in other TOAST groups. Previous studies on ESUS patients reported a prevalence of PFO of between 4% and 25% . The large variation is most probably due to incompleteness of diagnostic work‐up in these studies, especially the use of TEE and the transcranial Doppler bubble test.…”

Section: Discussionmentioning

confidence: 89%

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Embolic strokes of undetermined source in young adults: baseline characteristics and long‐term outcome

Martinez‐Majander

Aarnio

Pirinen

et al. 2018

Euro J of Neurology

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 89%

Embolic strokes of undetermined source in young adults: baseline characteristics and long‐term outcome

Martinez‐Majander

Aarnio

Pirinen

et al. 2018

Euro J of Neurology

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“…[12,18] This condition seems to be a distinctive consideration for ethiopathogenic sources in young stroke patients fulfilling ESUS criteria; in a small registry of young ESUS patients, minor embolic sources do not seem to be more prevalent in this population than in strokes of determined cause, which leads to the assumption that further explanations should be identified;[20] despite this, our recurrence rate was not statistically different from the recurrence rate of CS; which leads us to the rationale that even though this patients have been treated with oral antiplatelet drugs, according to current secondary prevention guidelines,[21,22] further therapies and diagnostic procedures should be encouraged among stroke professionals when studying and treating this population.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Functional Outcome and Stroke Recurrence in Patients with Embolic Stroke of Undetermined Source (ESUS) vs. Cardioembolic Stroke Patients

et al. 2016

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BackgroundEmbolic stroke of undetermined source (ESUS) recurrence and functional outcome from long-term follow-up is not well delineated. The purpose of this study is to compare these functional variables between ESUS vs. cardioembolic stroke (CS) patients.MethodsWe analyzed data of consecutive ESUS and CS patients from our institutional database, from January 2003 until April 2015. The endpoints were stroke recurrence, mortality and poor clinical outcome (Modified Rankin Score 3–6), at discharge, 6 months and final follow-up. Adjusted multivariate Cox analysis and Kaplan-Meier curves were used to estimate the probability of recurrence and death.Results149 ESUS (median age 44 years) and 235 CS (median age 66 years) consecutive patients were included in the study. Median follow-up period for the entire sample was 19 months (interquartile range 6.0–45.0 months). Stroke recurrence was similar between ESUS and CS patients (5.4% vs. 9.8% respectively, p = 0.12). Death occurred in 30 CS cases (12.8%), with a cumulative probability of survival of 77%. Poor functional outcome was present in 58.3%, 54.0% and 54.9% at discharge, 6 months and final follow-up respectively in CS patients, significantly worst compared to ESUS cases (HR 3.1; CI 95% 1.96–4.68). Oral anticoagulation presents with a HR 8.01 for recurrence, and antiplatelet therapy had the highest risk for recurrence for both groups (HR 24.3).ConclusionESUS patients are substantially younger than CS patients but have a stroke recurrence rate similar to CS patients, with a lower mortality rate, and better functional outcome on long-term follow-up.

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“…most young patients with cryptogenic IS may fulfil the recently proposed criteria for embolic stroke of undetermined source (ESUS) 22,23 therefore, apart from the often-studied atrial pathologies, there likely remain cardiac pathologies that go unnoticed with the current cardiac imaging focus; 24 . observing firm cardiac electrophysiological changes with for example signal-averaged electrocardiography (ECG) and magnetocardiography may reveal hints for cardiac pathology pre-disposing to cryptogenic IS; 25 .…”

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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Embolic stroke of unknown source (ESUS) in young patients

Abstract: Continuous variables are presented as mean (standard deviation). Nominal variables are presented as absolute number (percent).

Cited by 24 publications

References 1 publication

Embolic strokes of undetermined source in young adults: baseline characteristics and long‐term outcome

Embolic strokes of undetermined source in young adults: baseline characteristics and long‐term outcome

Comparison of Functional Outcome and Stroke Recurrence in Patients with Embolic Stroke of Undetermined Source (ESUS) vs. Cardioembolic Stroke Patients

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

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