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Embolic Stroke of Undetermined Source (ESUS): Prevalence, Risk Factors, and Diagnostic Insights from a Prospective German Cohort

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Název: Embolic Stroke of Undetermined Source (ESUS): Prevalence, Risk Factors, and Diagnostic Insights from a Prospective German Cohort
Autoři: Priyanka Boettger, Jamschid Sedighi, Martin Juenemann, Michael Buerke, Omar Alhaj Omar
Zdroj: Annals of Indian Academy of Neurology, Vol 28, Iss 5, Pp 684-692 (2025)
Informace o vydavateli: Wolters Kluwer Medknow Publications, 2025.
Rok vydání: 2025
Sbírka: LCC:Neurology. Diseases of the nervous system
Témata: esus, embolic stroke, cryptogenic stroke, stroke subtype comparison, stroke classification, secondary prevention, Neurology. Diseases of the nervous system, RC346-429
Popis: Background and Objectives: Embolic stroke of undetermined source (ESUS) was introduced to standardize the classification of cryptogenic strokes with presumed embolic origin. However, ESUS comprises a heterogeneous group with diverse clinical and diagnostic features. This study aimed to characterize ESUS within a prospective stroke cohort and compare it with other defined ischemic stroke subtypes. Methods: In this prospective, single-center study, patients with acute ischemic stroke or transient ischemic attack (TIA) were enrolled over 6 months. Stroke etiology was classified according to established criteria, including ESUS definitions based on the exclusion of major cardioembolic sources, ≥50% large-artery stenosis, and small-vessel disease. All patients underwent neuroimaging, vascular diagnostics, and cardiological workup, including echocardiography and rhythm monitoring. Results: Of 714 patients, 98 (13.7%) met ESUS criteria. ESUS patients were younger (median 67 vs. 74 years), predominantly male (61.2%), and had fewer prior strokes or TIAs (11.2% vs. 27.6%, P < 0.001) than nonESUS patients. Hypertension (72.2%) and obesity (54.2%) were common. Stroke severity at discharge was lower in ESUS (National Institutes of Health Stroke (NIHSS) 1.9 ± 2.3) compared to cardioembolic (4.8 ± 3.7) and atherosclerotic strokes (3.5 ± 3.1) (P < 0.05), and no in-hospital deaths occurred in the ESUS group (P = 0.02). While overall diagnostic imaging rates were similar across groups, transesophageal echocardiography was performed more frequently in ESUS (38.8%). Conclusions: ESUS accounted for 18% of ischemic strokes and represents a distinct, clinically relevant subgroup with unique demographic and outcome profiles. These findings support the refinement of ESUS classification and the need for individualized diagnostic and secondary prevention strategies.
Druh dokumentu: article
Popis souboru: electronic resource
Jazyk: English
ISSN: 0972-2327
1998-3549
Relation: https://journals.lww.com/10.4103/aian.aian_327_25; https://doaj.org/toc/0972-2327; https://doaj.org/toc/1998-3549
DOI: 10.4103/aian.aian_327_25
Přístupová URL adresa: https://doaj.org/article/ca228c3ae3ad4164a8a0472abe8e8ca0
Přístupové číslo: edsdoj.228c3ae3ad4164a8a0472abe8e8ca0
Databáze: Directory of Open Access Journals
Popis
Abstrakt:Background and Objectives: Embolic stroke of undetermined source (ESUS) was introduced to standardize the classification of cryptogenic strokes with presumed embolic origin. However, ESUS comprises a heterogeneous group with diverse clinical and diagnostic features. This study aimed to characterize ESUS within a prospective stroke cohort and compare it with other defined ischemic stroke subtypes. Methods: In this prospective, single-center study, patients with acute ischemic stroke or transient ischemic attack (TIA) were enrolled over 6 months. Stroke etiology was classified according to established criteria, including ESUS definitions based on the exclusion of major cardioembolic sources, ≥50% large-artery stenosis, and small-vessel disease. All patients underwent neuroimaging, vascular diagnostics, and cardiological workup, including echocardiography and rhythm monitoring. Results: Of 714 patients, 98 (13.7%) met ESUS criteria. ESUS patients were younger (median 67 vs. 74 years), predominantly male (61.2%), and had fewer prior strokes or TIAs (11.2% vs. 27.6%, P < 0.001) than nonESUS patients. Hypertension (72.2%) and obesity (54.2%) were common. Stroke severity at discharge was lower in ESUS (National Institutes of Health Stroke (NIHSS) 1.9 ± 2.3) compared to cardioembolic (4.8 ± 3.7) and atherosclerotic strokes (3.5 ± 3.1) (P < 0.05), and no in-hospital deaths occurred in the ESUS group (P = 0.02). While overall diagnostic imaging rates were similar across groups, transesophageal echocardiography was performed more frequently in ESUS (38.8%). Conclusions: ESUS accounted for 18% of ischemic strokes and represents a distinct, clinically relevant subgroup with unique demographic and outcome profiles. These findings support the refinement of ESUS classification and the need for individualized diagnostic and secondary prevention strategies.
ISSN:09722327
19983549
DOI:10.4103/aian.aian_327_25