Embolic stroke of undetermined source: a retrospective analysis from an Italian Stroke Unit

Submitted: 29 January 2016
Accepted: 1 June 2016
Published: 30 September 2016
Abstract Views: 1517
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The new clinical construct of embolic stroke of undetermined source (ESUS) suggests that many cryptogenic strokes are related to minor-risk covert embolic cardiac sources or to embolus from non-occlusive plaques in the aortic arch or in the cerebral arteries. The authors analyzed the prevalence of ESUS in a real-life condition in Italy and compared the recurrence rates in cryptogenic strokes, cardioembolic strokes, and ESUS. The authors retrospectively reassessed according to ESUS criteria 391 consecutive admissions in a stroke unit where extensive diagnostic search was routinely performed. Recurrences in each stroke type within a 3-year follow-up period (mean time: 25.44 months - standard deviation: 9.42) were also compared. The prevalence of ESUS in the aforementioned cohort was 10.5%. All ESUS patients received antiplatelet agents. Warfarin was prescribed in 56.9% of cardioembolic strokes. The recurrence rate in ESUS patients was 4.4% per year, slightly higher than in cardioembolic strokes (3.5%) and significantly higher than in cryptogenic non-ESUS (1.2%) (P<0.0001). This is the first description of a cohort of ESUS patients in an Italian stroke unit. Patients with ESUS have a significantly higher risk of recurrence than in those with non-ESUS cryptogenic strokes, and slightly higher than in those with cardioembolic strokes. Results support the hypothesis of a more extensive diagnostic evaluation in cryptogenic strokes and the feasibility of such approach.

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Marco Masina, Stroke Care Area - Geriatric Ward, Bentivoglio Hospital, Bentivoglio (BO)
Geriatrician, Director of Geriatric Complex Unit and Stroke Care Area - Bentivoglio Hospital - Azienda USL di Bologna, Italy
Annalena Cicognani, Stroke Care Area - Geriatric Ward, Bentivoglio Hospital, Bentivoglio (BO)
Geriatrician - Stroke Care Area and Geriatric Ward - Bentivoglio Hospital - Azienda USL di Bologna, Italy
Carla Lofiego, Cardiology and Intensive Cardiac Unit, Bentivoglio Hospital, Bentivoglio (BO)
Cardiologist, Cardiology and Intensive Cardiac Unit, Bentivoglio Hospital, Bentivoglio, AUSL di Bologna, Italy
Simona Malservisi, Stroke Care Area - Geriatric Ward, Bentivoglio Hospital, Bentivoglio (BO)
Geriatrician , Stroke Care Area Geriatric Ward, Bentivoglio Hospital, Bentivoglio, AUSL di Bologna, Italy
Riccardo Parlangeli, Cardiology and Intensive Cardiac Unit, Bentivoglio Hospital, Bentivoglio (BO)
Cardiologist, Cardiology and Intensive Cardiac Unit, Bentivoglio Hospital, Bentivoglio, AUSL di Bologna, Italy
Alessandro Lombardi, Cardiology and Intensive Cardiac Unit, Bentivoglio Hospital, Bentivoglio (BO)
Cardiologist, Clinical Lead , Cardiology and Intensive Cardiac Unit, Bentivoglio Hospital, Bentivoglio, AUSL di Bologna, Italy

How to Cite

Masina, M., Cicognani, A., Lofiego, C., Malservisi, S., Parlangeli, R., & Lombardi, A. (2016). Embolic stroke of undetermined source: a retrospective analysis from an Italian Stroke Unit. Italian Journal of Medicine, 10(3), 202–206. https://doi.org/10.4081/itjm.2016.690

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