Embolic strokes of undetermined source: Prevalence and patient features in the ESUS Global Registry

Kanjana S. Perera; Thomas Vanassche; Jackie Bosch; Mohana Giruparajah; Balakumar Swaminathan; Katie R. Mattina; Scott D. Berkowitz; Antonio Arauz; Martin J. O'Donnell; Sebastian F. Ameriso; Graeme J. Hankey; Byung Woo Yoon; Philippa Lavallee; Luis Cunha; Nikolay Shamalov; Raf Brouns; Rubens J. Gagliardi; Scott E. Kasner; Alessio Pieroni; Philipp Vermehren; Kazuo Kitagawa; Yongjun Wang; Keith Muir; Jonathan Coutinho; Ildiko Vastagh; Stuart J. Connolly; Robert G. Hart; K. Czeto; M. Kahn; M. Gomez Schneider; V. Pujol Lereis; M. Hawkes; L. Pertierra; N. Perera; A. De Smedt; R. Van Dyck; R. J. Van Hooff; L. Yperzeele; V. D. Baptista Gagliardi; L. G. Cerqueir; X. Yang; W. Chen; P. Amarenco; C. Guidoux; P. A. Ringleb; D. Bereczki; M. Canavan; D. Toni; A. Anzini; C. Colosimo; M. De Michele; M. T. Di Mascio; L. Durastanti; A. Falcou; S. Fausti; A. Mancini; S. Mizumo; S. Uchiyama; C. K. Kim; S. Jung; Y. Kim; J. A. Kim; J. Y. Jo; M. Barboza; A. Quiroz-Compean; J. Colin; P. J. Nederkoorn; A. Roxas; V. Perez Marianito; G. Santo; F. Silva; J. Sargento-Freitas; J. Coelho; M. Kustova; K. Meshkova; G. Williams; J. Siegler; C. Zhang; N. Gallatti; M. Kruszewski

doi:10.1177/1747493016641967

Embolic strokes of undetermined source: Prevalence and patient features in the ESUS Global Registry

Kanjana S. Perera, Thomas Vanassche, Jackie Bosch, Mohana Giruparajah, Balakumar Swaminathan, Katie R. Mattina, Scott D. Berkowitz, Antonio Arauz, Martin J. O'Donnell, Sebastian F. Ameriso, Graeme J. Hankey, Byung Woo Yoon, Philippa Lavallee, Luis Cunha, Nikolay Shamalov, Raf Brouns, Rubens J. Gagliardi, Scott E. Kasner, Alessio Pieroni, Philipp VermehrenKazuo Kitagawa, Yongjun Wang, Keith Muir, Jonathan Coutinho, Ildiko Vastagh, Stuart J. Connolly, Robert G. Hart, K. Czeto, M. Kahn, M. Gomez Schneider, V. Pujol Lereis, M. Hawkes, L. Pertierra, N. Perera, A. De Smedt, R. Van Dyck, R. J. Van Hooff, L. Yperzeele, V. D. Baptista Gagliardi, L. G. Cerqueir, X. Yang, W. Chen, P. Amarenco, C. Guidoux, P. A. Ringleb, D. Bereczki, M. Canavan, D. Toni, A. Anzini, C. Colosimo, M. De Michele, M. T. Di Mascio, L. Durastanti, A. Falcou, S. Fausti, A. Mancini, S. Mizumo, S. Uchiyama, C. K. Kim, S. Jung, Y. Kim, J. A. Kim, J. Y. Jo, M. Barboza, A. Quiroz-Compean, J. Colin, P. J. Nederkoorn, A. Roxas, V. Perez Marianito, G. Santo, F. Silva, J. Sargento-Freitas, J. Coelho, M. Kustova, K. Meshkova, G. Williams, J. Siegler, C. Zhang, N. Gallatti, M. Kruszewski

* New professors

Research output: Contribution to journal › Article › peer-review

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Abstract

Background: Recent evidence supports that most non-lacunar cryptogenic strokes are embolic. Accordingly, these strokes have been designated as embolic strokes of undetermined source (ESUS). Aims: We undertook an international survey to characterize the frequency and clinical features of ESUS patients across global regions. Methods: Consecutive patients hospitalized for ischemic stroke were retrospectively surveyed from 19 stroke research centers in 19 different countries to collect patients meeting criteria for ESUS. Results: Of 2144 patients with recent ischemic stroke, 351 (16%, 95% CI 15% to 18%) met ESUS criteria, similar across global regions (range 16% to 21%), and an additional 308 (14%) patients had incomplete evaluation required for ESUS diagnosis. The mean age of ESUS patients (62 years; SD = 15) was significantly lower than the 1793 non-ESUS ischemic stroke patients (68 years, p ≤ 0.001). Excluding patients with atrial fibrillation (n = 590, mean age = 75 years), the mean age of the remaining 1203 non-ESUS ischemic stroke patients was 64 years (p = 0.02 vs. ESUS patients). Among ESUS patients, hypertension, diabetes, and prior stroke were present in 64%, 25%, and 17%, respectively. Median NIHSS score was 4 (interquartile range 2-8). At discharge, 90% of ESUS patients received antiplatelet therapy and 7% received anticoagulation. Conclusions: This cross-sectional global sample of patients with recent ischemic stroke shows that one-sixth met criteria for ESUS, with additional ESUS patients likely among those with incomplete diagnostic investigation. ESUS patients were relatively young with mild strokes. Antiplatelet therapy was the standard antithrombotic therapy for secondary stroke prevention in all global regions.

Original language	English
Pages (from-to)	526-533
Number of pages	8
Journal	International Journal of Stroke
Volume	11
Issue number	5
DOIs	https://doi.org/10.1177/1747493016641967
Publication status	Published - 2016 Jul

Keywords

Atrial fibrillation
Cerebral embolism
Diagnostic evaluation
Embolism
Stroke
Stroke-etiology

ASJC Scopus subject areas

Neurology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1177/1747493016641967

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Perera, K. S., Vanassche, T., Bosch, J., Giruparajah, M., Swaminathan, B., Mattina, K. R., Berkowitz, S. D., Arauz, A., O'Donnell, M. J., Ameriso, S. F., Hankey, G. J., Yoon, B. W., Lavallee, P., Cunha, L., Shamalov, N., Brouns, R., Gagliardi, R. J., Kasner, S. E., Pieroni, A., ... Kruszewski, M. (2016). Embolic strokes of undetermined source: Prevalence and patient features in the ESUS Global Registry. International Journal of Stroke, 11(5), 526-533. https://doi.org/10.1177/1747493016641967

Perera, KS, Vanassche, T, Bosch, J, Giruparajah, M, Swaminathan, B, Mattina, KR, Berkowitz, SD, Arauz, A, O'Donnell, MJ, Ameriso, SF, Hankey, GJ, Yoon, BW, Lavallee, P, Cunha, L, Shamalov, N, Brouns, R, Gagliardi, RJ, Kasner, SE, Pieroni, A, Vermehren, P, Kitagawa, K, Wang, Y, Muir, K, Coutinho, J, Vastagh, I, Connolly, SJ, Hart, RG, Czeto, K, Kahn, M, Gomez Schneider, M, Pujol Lereis, V, Hawkes, M, Pertierra, L, Perera, N, De Smedt, A, Van Dyck, R, Van Hooff, RJ, Yperzeele, L, Baptista Gagliardi, VD, Cerqueir, LG, Yang, X, Chen, W, Amarenco, P, Guidoux, C, Ringleb, PA, Bereczki, D, Canavan, M, Toni, D, Anzini, A, Colosimo, C, De Michele, M, Di Mascio, MT, Durastanti, L, Falcou, A, Fausti, S, Mancini, A, Mizumo, S, Uchiyama, S, Kim, CK, Jung, S, Kim, Y, Kim, JA, Jo, JY, Barboza, M, Quiroz-Compean, A, Colin, J, Nederkoorn, PJ, Roxas, A, Perez Marianito, V, Santo, G, Silva, F, Sargento-Freitas, J, Coelho, J, Kustova, M, Meshkova, K, Williams, G, Siegler, J, Zhang, C, Gallatti, N & Kruszewski, M 2016, 'Embolic strokes of undetermined source: Prevalence and patient features in the ESUS Global Registry', International Journal of Stroke, vol. 11, no. 5, pp. 526-533. https://doi.org/10.1177/1747493016641967

@article{695e5598eecf45d98ec72698dc0fd211,

title = "Embolic strokes of undetermined source: Prevalence and patient features in the ESUS Global Registry",

abstract = "Background: Recent evidence supports that most non-lacunar cryptogenic strokes are embolic. Accordingly, these strokes have been designated as embolic strokes of undetermined source (ESUS). Aims: We undertook an international survey to characterize the frequency and clinical features of ESUS patients across global regions. Methods: Consecutive patients hospitalized for ischemic stroke were retrospectively surveyed from 19 stroke research centers in 19 different countries to collect patients meeting criteria for ESUS. Results: Of 2144 patients with recent ischemic stroke, 351 (16%, 95% CI 15% to 18%) met ESUS criteria, similar across global regions (range 16% to 21%), and an additional 308 (14%) patients had incomplete evaluation required for ESUS diagnosis. The mean age of ESUS patients (62 years; SD = 15) was significantly lower than the 1793 non-ESUS ischemic stroke patients (68 years, p ≤ 0.001). Excluding patients with atrial fibrillation (n = 590, mean age = 75 years), the mean age of the remaining 1203 non-ESUS ischemic stroke patients was 64 years (p = 0.02 vs. ESUS patients). Among ESUS patients, hypertension, diabetes, and prior stroke were present in 64%, 25%, and 17%, respectively. Median NIHSS score was 4 (interquartile range 2-8). At discharge, 90% of ESUS patients received antiplatelet therapy and 7% received anticoagulation. Conclusions: This cross-sectional global sample of patients with recent ischemic stroke shows that one-sixth met criteria for ESUS, with additional ESUS patients likely among those with incomplete diagnostic investigation. ESUS patients were relatively young with mild strokes. Antiplatelet therapy was the standard antithrombotic therapy for secondary stroke prevention in all global regions.",

keywords = "Atrial fibrillation, Cerebral embolism, Diagnostic evaluation, Embolism, Stroke, Stroke-etiology",

author = "Perera, {Kanjana S.} and Thomas Vanassche and Jackie Bosch and Mohana Giruparajah and Balakumar Swaminathan and Mattina, {Katie R.} and Berkowitz, {Scott D.} and Antonio Arauz and O'Donnell, {Martin J.} and Ameriso, {Sebastian F.} and Hankey, {Graeme J.} and Yoon, {Byung Woo} and Philippa Lavallee and Luis Cunha and Nikolay Shamalov and Raf Brouns and Gagliardi, {Rubens J.} and Kasner, {Scott E.} and Alessio Pieroni and Philipp Vermehren and Kazuo Kitagawa and Yongjun Wang and Keith Muir and Jonathan Coutinho and Ildiko Vastagh and Connolly, {Stuart J.} and Hart, {Robert G.} and K. Czeto and M. Kahn and {Gomez Schneider}, M. and {Pujol Lereis}, V. and M. Hawkes and L. Pertierra and N. Perera and {De Smedt}, A. and {Van Dyck}, R. and {Van Hooff}, {R. J.} and L. Yperzeele and {Baptista Gagliardi}, {V. D.} and Cerqueir, {L. G.} and X. Yang and W. Chen and P. Amarenco and C. Guidoux and Ringleb, {P. A.} and D. Bereczki and M. Canavan and D. Toni and A. Anzini and C. Colosimo and {De Michele}, M. and {Di Mascio}, {M. T.} and L. Durastanti and A. Falcou and S. Fausti and A. Mancini and S. Mizumo and S. Uchiyama and Kim, {C. K.} and S. Jung and Y. Kim and Kim, {J. A.} and Jo, {J. Y.} and M. Barboza and A. Quiroz-Compean and J. Colin and Nederkoorn, {P. J.} and A. Roxas and {Perez Marianito}, V. and G. Santo and F. Silva and J. Sargento-Freitas and J. Coelho and M. Kustova and K. Meshkova and G. Williams and J. Siegler and C. Zhang and N. Gallatti and M. Kruszewski",

note = "Publisher Copyright: {\textcopyright} 2016 World Stroke Organization.",

year = "2016",

month = jul,

doi = "10.1177/1747493016641967",

language = "English",

volume = "11",

pages = "526--533",

journal = "International Journal of Stroke",

issn = "1747-4930",

publisher = "Wiley-Blackwell",

number = "5",

}

TY - JOUR

T1 - Embolic strokes of undetermined source

T2 - Prevalence and patient features in the ESUS Global Registry

AU - Perera, Kanjana S.

AU - Vanassche, Thomas

AU - Bosch, Jackie

AU - Giruparajah, Mohana

AU - Swaminathan, Balakumar

AU - Mattina, Katie R.

AU - Berkowitz, Scott D.

AU - Arauz, Antonio

AU - O'Donnell, Martin J.

AU - Ameriso, Sebastian F.

AU - Hankey, Graeme J.

AU - Yoon, Byung Woo

AU - Lavallee, Philippa

AU - Cunha, Luis

AU - Shamalov, Nikolay

AU - Brouns, Raf

AU - Gagliardi, Rubens J.

AU - Kasner, Scott E.

AU - Pieroni, Alessio

AU - Vermehren, Philipp

AU - Kitagawa, Kazuo

AU - Wang, Yongjun

AU - Muir, Keith

AU - Coutinho, Jonathan

AU - Vastagh, Ildiko

AU - Connolly, Stuart J.

AU - Hart, Robert G.

AU - Czeto, K.

AU - Kahn, M.

AU - Gomez Schneider, M.

AU - Pujol Lereis, V.

AU - Hawkes, M.

AU - Pertierra, L.

AU - Perera, N.

AU - De Smedt, A.

AU - Van Dyck, R.

AU - Van Hooff, R. J.

AU - Yperzeele, L.

AU - Baptista Gagliardi, V. D.

AU - Cerqueir, L. G.

AU - Yang, X.

AU - Chen, W.

AU - Amarenco, P.

AU - Guidoux, C.

AU - Ringleb, P. A.

AU - Bereczki, D.

AU - Canavan, M.

AU - Toni, D.

AU - Anzini, A.

AU - Colosimo, C.

AU - De Michele, M.

AU - Di Mascio, M. T.

AU - Durastanti, L.

AU - Falcou, A.

AU - Fausti, S.

AU - Mancini, A.

AU - Mizumo, S.

AU - Uchiyama, S.

AU - Kim, C. K.

AU - Jung, S.

AU - Kim, Y.

AU - Kim, J. A.

AU - Jo, J. Y.

AU - Barboza, M.

AU - Quiroz-Compean, A.

AU - Colin, J.

AU - Nederkoorn, P. J.

AU - Roxas, A.

AU - Perez Marianito, V.

AU - Santo, G.

AU - Silva, F.

AU - Sargento-Freitas, J.

AU - Coelho, J.

AU - Kustova, M.

AU - Meshkova, K.

AU - Williams, G.

AU - Siegler, J.

AU - Zhang, C.

AU - Gallatti, N.

AU - Kruszewski, M.

PY - 2016/7

Y1 - 2016/7

N2 - Background: Recent evidence supports that most non-lacunar cryptogenic strokes are embolic. Accordingly, these strokes have been designated as embolic strokes of undetermined source (ESUS). Aims: We undertook an international survey to characterize the frequency and clinical features of ESUS patients across global regions. Methods: Consecutive patients hospitalized for ischemic stroke were retrospectively surveyed from 19 stroke research centers in 19 different countries to collect patients meeting criteria for ESUS. Results: Of 2144 patients with recent ischemic stroke, 351 (16%, 95% CI 15% to 18%) met ESUS criteria, similar across global regions (range 16% to 21%), and an additional 308 (14%) patients had incomplete evaluation required for ESUS diagnosis. The mean age of ESUS patients (62 years; SD = 15) was significantly lower than the 1793 non-ESUS ischemic stroke patients (68 years, p ≤ 0.001). Excluding patients with atrial fibrillation (n = 590, mean age = 75 years), the mean age of the remaining 1203 non-ESUS ischemic stroke patients was 64 years (p = 0.02 vs. ESUS patients). Among ESUS patients, hypertension, diabetes, and prior stroke were present in 64%, 25%, and 17%, respectively. Median NIHSS score was 4 (interquartile range 2-8). At discharge, 90% of ESUS patients received antiplatelet therapy and 7% received anticoagulation. Conclusions: This cross-sectional global sample of patients with recent ischemic stroke shows that one-sixth met criteria for ESUS, with additional ESUS patients likely among those with incomplete diagnostic investigation. ESUS patients were relatively young with mild strokes. Antiplatelet therapy was the standard antithrombotic therapy for secondary stroke prevention in all global regions.

AB - Background: Recent evidence supports that most non-lacunar cryptogenic strokes are embolic. Accordingly, these strokes have been designated as embolic strokes of undetermined source (ESUS). Aims: We undertook an international survey to characterize the frequency and clinical features of ESUS patients across global regions. Methods: Consecutive patients hospitalized for ischemic stroke were retrospectively surveyed from 19 stroke research centers in 19 different countries to collect patients meeting criteria for ESUS. Results: Of 2144 patients with recent ischemic stroke, 351 (16%, 95% CI 15% to 18%) met ESUS criteria, similar across global regions (range 16% to 21%), and an additional 308 (14%) patients had incomplete evaluation required for ESUS diagnosis. The mean age of ESUS patients (62 years; SD = 15) was significantly lower than the 1793 non-ESUS ischemic stroke patients (68 years, p ≤ 0.001). Excluding patients with atrial fibrillation (n = 590, mean age = 75 years), the mean age of the remaining 1203 non-ESUS ischemic stroke patients was 64 years (p = 0.02 vs. ESUS patients). Among ESUS patients, hypertension, diabetes, and prior stroke were present in 64%, 25%, and 17%, respectively. Median NIHSS score was 4 (interquartile range 2-8). At discharge, 90% of ESUS patients received antiplatelet therapy and 7% received anticoagulation. Conclusions: This cross-sectional global sample of patients with recent ischemic stroke shows that one-sixth met criteria for ESUS, with additional ESUS patients likely among those with incomplete diagnostic investigation. ESUS patients were relatively young with mild strokes. Antiplatelet therapy was the standard antithrombotic therapy for secondary stroke prevention in all global regions.

KW - Atrial fibrillation

KW - Cerebral embolism

KW - Diagnostic evaluation

KW - Embolism

KW - Stroke

KW - Stroke-etiology

UR - http://www.scopus.com/inward/record.url?scp=84969941468&partnerID=8YFLogxK

U2 - 10.1177/1747493016641967

DO - 10.1177/1747493016641967

M3 - Article

C2 - 27256472

AN - SCOPUS:84969941468

SN - 1747-4930

VL - 11

SP - 526

EP - 533

JO - International Journal of Stroke

JF - International Journal of Stroke

IS - 5

ER -

Embolic strokes of undetermined source: Prevalence and patient features in the ESUS Global Registry

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Keywords

ASJC Scopus subject areas

UN SDGs

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