Risk of recurrent ischemic stroke in young cryptogenic patients with embolic stroke of undetermined source

Šaňák, Daniel; Divišová, Petra; Hutyra, Martin; Král, Michal; Bártková, Andrea; Zapletalová, Jana; Látal, Jan; Dorňák, Tomáš; Hudec, Štěpán; Franc, David; Polidar, Petr; Veverka, Tomáš; Kaňovský, Petr

doi:10.1016/j.jns.2020.116985

Cited by 3 publications

(1 citation statement)

References 29 publications

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“…Few previous studies have investigated the long-term outcome of young IS patients. However, those that did were either singlecenter studies [8][9][10][11][12][13] or had short follow-up periods [14,15]. The Stroke in Young Fabry Patients (SIFAP) study is, to our knowledge, the largest multicenter, prospective study of young stroke patients with 5023 patients from 47 centers [16].…”

Section: Introductionmentioning

confidence: 99%

Long‐term risk of recurrent vascular events and mortality in young stroke patients: Insights from a multicenter study

Broman

Fandler‐Höfler

Sarnowski

et al. 2023

Euro J of Neurology

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Background Although the incidence of stroke in the young is rising, data on long‐term outcomes in these patients are scarce. We thus aimed to investigate the long‐term risk of recurrent vascular events and mortality in a multicenter study. Methods We followed 396 consecutive patients aged 18–55 years with ischemic stroke (IS) or transient ischemic attack (TIA) enrolled in three European centers during the period 2007–2010. A detailed outpatient clinical follow‐up assessment was performed between 2018 and 2020. When an in‐person follow‐up visit was not possible, outcome events were assessed using electronic records and registry data. Results During a median follow‐up of 11.8 (IQR 10.4–12.7) years, 89 (22.5%) patients experienced any recurrent vascular event, 62 (15.7%) had any cerebrovascular event, 34 (8.6%) had other vascular events, and 27 (6.8%) patients died. Cumulative 10‐year incidence rate per 1000 person‐years was 21.6 (95% CI 17.1–26.9) for any recurrent vascular event and 14.9 (95% CI 11.3–19.3) for any cerebrovascular event. The prevalence of cardiovascular risk factors increased over time, and 22 (13.5%) patients lacked any secondary preventive medication at the in‐person follow‐up. After adjustment for demographics and comorbidities, atrial fibrillation at baseline was found to be significantly associated with recurrent vascular events. Conclusions This multicenter study shows a considerable risk of recurrent vascular events in young IS and TIA patients. Further studies should investigate whether detailed individual risk assessment, modern secondary preventive strategies, and better patient adherence may reduce recurrence risk.

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Section: Introductionmentioning

confidence: 99%

Long‐term risk of recurrent vascular events and mortality in young stroke patients: Insights from a multicenter study

Broman

Fandler‐Höfler

Sarnowski

et al. 2023

Euro J of Neurology

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Etiologies, mechanisms, and risk factors of ischemic stroke in a young Asian adult cohort

Tan¹,

Ho²,

Sia³

et al. 2023

Journal of Stroke and Cerebrovascular Diseases

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Predictive value of transesophageal echocardiography combined with contrast transthoracic echocardiography for embolic stroke of undetermined source

Huang,

Wang

2023

Perfusion

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Objective In this study, we aimed to assess the predictive value of transesophageal echocardiography (TEE) combined with contrast transthoracic echocardiography (cTTE) for embolic stroke of undetermined source (ESUS). Methods A total of 52 patients with ESUS were examined by TEE and cTTE. The detection rate of patent foramen ovale (PFO) and right-to-left shunt (RLS) grade were compared in patients with ESUS between cTTE alone and cTTE combined with TEE. The Risk of Paradoxical Embolism (RoPE) score, PFO diameter, and PFO length of patients with PFO-associated ESUS and non-PFO-associated ESUS were compared by cTTE alone and cTTE combined with TEE. The receiver operating characteristic (ROC) curve was utilized to determine the effect of RoPE score and PFO diameter on patients with PFO-associated ESUS. Results The positive rate of PFO detected by cTTE alone (46.15%) was lower than that detected by cTTE combined with TEE (69.23%). The proportion of patients with RLS grade I + II + III detected by cTTE combined with TEE (69.23%) was higher than that detected by cTTE alone (46.15%). Both the RoPE score and PFO diameter were significantly greater in the patients with PFO-associated ESUS than in the patients with non-PFO-associated ESUS ( p < .05). The combination of RoPE score and PFO diameter had the largest area under the ROC curve (AUC = 0.875), which was larger than the AUC alone of RoPE score (AUC = 0.819) and PFO diameter (AUC = 0.783) ( p < .05). Conclusion The combination of cTTE and TEE is helpful to the diagnosis of ESUS patients caused by PFO and to judge the degree of RLS.

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Risk of recurrent ischemic stroke in young cryptogenic patients with embolic stroke of undetermined source

Cited by 3 publications

References 29 publications

Long‐term risk of recurrent vascular events and mortality in young stroke patients: Insights from a multicenter study

Long‐term risk of recurrent vascular events and mortality in young stroke patients: Insights from a multicenter study

Etiologies, mechanisms, and risk factors of ischemic stroke in a young Asian adult cohort

Predictive value of transesophageal echocardiography combined with contrast transthoracic echocardiography for embolic stroke of undetermined source

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