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Embolic Stroke of Undetermined Source
Journal of the American College of Cardiology ( IF 21.7 ) Pub Date : 2020-01-01 , DOI: 10.1016/j.jacc.2019.11.024 George Ntaios 1
Journal of the American College of Cardiology ( IF 21.7 ) Pub Date : 2020-01-01 , DOI: 10.1016/j.jacc.2019.11.024 George Ntaios 1
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The term embolic stroke of undetermined source (ESUS) was introduced in 2014 to describe patients with a nonlacunar ischemic stroke and no convincing etiology. The terms ESUS and cryptogenic stroke are not synonyms, as the latter also includes patients with multiple stroke etiologies or incomplete diagnostic work-up. ESUS involves approximately 17% of all ischemic stroke patients, and these patients are typically younger with mild strokes and an annual rate of stroke recurrence of 4% to 5%. It was hypothesized that oral anticoagulation may decrease the risk of stroke recurrence in ESUS, which was tested in 2 large randomized controlled trials: the NAVIGATE ESUS (Rivaroxaban Versus Aspirin in Secondary Prevention of Stroke and Prevention of Systemic Embolism in Patients With Recent Embolic Stroke of Undetermined Source) and the RE-SPECT ESUS (Dabigatran Etexilate for Secondary Stroke Prevention in Patients With Embolic Stroke of Undetermined Source). The present review discusses the trials of anticoagulation in patients with ESUS, suggests potential explanations for their neutral results, and highlights the rationale that supports ongoing and future research in this population aiming to reduce the associated risk for stroke recurrence.
中文翻译：
来源不明的栓塞性卒中
不明来源栓塞性卒中 (ESUS) 一词于 2014 年引入，用于描述非腔隙性缺血性卒中且没有令人信服的病因的患者。术语 ESUS 和隐源性卒中不是同义词，因为后者还包括具有多种卒中病因或不完整诊断检查的患者。ESUS 约占所有缺血性卒中患者的 17%，这些患者通常较年轻，有轻度卒中，年卒中复发率为 4% 至 5%。2 项大型随机对照试验验证了口服抗凝治疗可能降低 ESUS 卒中复发风险的假设：NAVIGATE ESUS（利伐沙班与阿司匹林在近期不明来源栓塞性中风患者中用于二级预防中风和预防全身性栓塞）和 RE-SPECT ESUS（达比加群酯用于不明来源栓塞性中风患者的二级中风预防）。本综述讨论了 ESUS 患者的抗凝试验，对其中性结果提出了可能的解释，并强调了支持该人群正在进行和未来旨在降低卒中复发相关风险的研究的基本原理。
更新日期：2020-01-01
中文翻译：
来源不明的栓塞性卒中
不明来源栓塞性卒中 (ESUS) 一词于 2014 年引入，用于描述非腔隙性缺血性卒中且没有令人信服的病因的患者。术语 ESUS 和隐源性卒中不是同义词，因为后者还包括具有多种卒中病因或不完整诊断检查的患者。ESUS 约占所有缺血性卒中患者的 17%，这些患者通常较年轻，有轻度卒中，年卒中复发率为 4% 至 5%。2 项大型随机对照试验验证了口服抗凝治疗可能降低 ESUS 卒中复发风险的假设：NAVIGATE ESUS（利伐沙班与阿司匹林在近期不明来源栓塞性中风患者中用于二级预防中风和预防全身性栓塞）和 RE-SPECT ESUS（达比加群酯用于不明来源栓塞性中风患者的二级中风预防）。本综述讨论了 ESUS 患者的抗凝试验，对其中性结果提出了可能的解释，并强调了支持该人群正在进行和未来旨在降低卒中复发相关风险的研究的基本原理。
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