#WeekendLecture
#ESUS
In most studies ~25% of ischemic stroke are classified as #cryptogenic
In 2014 the Embolic Stroke of Undetermined Source clinical construct was introduced, as a subset from cryptogenics
Criteria & diagnostic assessment were proposed
thelancet.com/journals/laneu…
#WeekendLecture
#ESUS
Although a long list of causes was described, covert AF was conceived as perhaps the most important underlying mechanism
It was hypothesized that oral #anticoagulation may⏬ the risk of stroke recurence in #ESUS
#WeekendLecture
#ESUS
A systematic review in 2017 (from several authors of the pivotal paper) showed:
👉Frequency: 17% (9-25%) of IS
👉Mean age: 65
👉Recurrence: 4.5% per year
👉Younger, lower freq of vascular RFs and milder stroke vs non-ESUS IS
ahajournals.org/doi/10.1161/st…
#WeekendLecture
#ESUS
Benefits from #anticoagulation hypothesis was studied in 2 RCT
👉#NAVIGATE_ESUS 2018
nejm.org/doi/10.1056/NE…
👉#RESPECT_ESUS 2019
nejm.org/doi/10.1056/NE…
☝️Oral anticoagulation was not associated with lower rates of stroke recurrence compared with aspirin
#WeekendLecture
#ESUS
Researchers have been highlighting other possible #ESUS etiologies, relationship with AF, & subanalysis trying to identify pts who could benefit from specific therapies
ie:
Carotid Plaques n.neurology.org/content/92/23/…
Atrial Cardiopathy
onlinelibrary.wiley.com/doi/10.1002/br…
#WeekendLecture
#ESUS
Currently #ongoing RCTs are using more strict criteria, recruiting subgroups that may respond better to anticoagulation
👉#ARCADIA
journals.sagepub.com/doi/abs/10.117…
👉#ATTICUS journals.sagepub.com/doi/abs/10.117…
#WeekendLecture
#ESUS
Recently, a group of experts made a "reexamination" of #ESUS construct, and proposed to #refine its definition, based on current evidence, ie, from #longterm monitoring, imaging, #atrial cardiopathy.
👉ahajournals.org/doi/10.1161/ST…
#WeekendLecture
#ESUS
If you want to go deeper in #ESUS we suggest you to read this 2 reviews
👉From @hoomankamel co-PI from ARCADIA, via @JAMANeuro
jamanetwork.com/journals/jaman…
👉From @GeorgeNtaios from NAVIGATE via @JACCJournals
sciencedirect.com/science/articl…
Thank you!!
#NeuroTwitter
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