Diagnosis and Treatment for embolic stroke of undetermined source: Consensus statement from the Taiwan stroke society and Taiwan society of cardiology
Cryptogenic stroke comprises about one-quarter of ischemic strokes with high recurrence rate; however, studies specifically investigating the features and treatment of this stroke subtype are rare. The concept of ‘embolic stroke of undetermined source’ (ESUS) may facilitate the development of a stan...
Main Authors: | , , , , , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Elsevier
2021-01-01
|
Series: | Journal of the Formosan Medical Association |
Subjects: | |
Online Access: | http://www.sciencedirect.com/science/article/pii/S0929664620302163 |
id |
doaj-a39e81509f0847f6b93efdfecb6e7a9b |
---|---|
record_format |
Article |
spelling |
doaj-a39e81509f0847f6b93efdfecb6e7a9b2020-11-27T04:18:27ZengElsevierJournal of the Formosan Medical Association0929-66462021-01-01120193106Diagnosis and Treatment for embolic stroke of undetermined source: Consensus statement from the Taiwan stroke society and Taiwan society of cardiologyLi-Kai Tsai0I-Hui Lee1Yung-Lung Chen2Tze-Fan Chao3Yu-Wei Chen4Helen L. Po5Li-Ming Lien6Pao-Hsien Chu7Wei-Chun Huang8Tsung-Hsien Lin9Ming-Tai Lin10Jiann-Shing Jeng11Juey-Jen Hwang12Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, TaiwanDepartment of Neurology, Neurological Institute, Taipei Veteran General Hospital, Taipei, TaiwanDivision of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, TaiwanDivision of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, TaiwanStroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan; Department of Neurology, Landseed International Hospital, Taoyuan, TaiwanStroke Center and Department of Neurology, MacKay Memorial Hospital, Taipei, TaiwanDepartment of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, TaiwanDepartment of Cardiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, TaiwanDepartment of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, TaiwanDivision of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, TaiwanDivision of Pediatric Cardiology, National Taiwan University Hospital, Taipei, TaiwanStroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan; Corresponding author. No. 7, Chung-Shan South Road, Taipei, 100, Taiwan.Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Corresponding author. No. 7, Chung-Shan South Road, Taipei, 100, Taiwan.Cryptogenic stroke comprises about one-quarter of ischemic strokes with high recurrence rate; however, studies specifically investigating the features and treatment of this stroke subtype are rare. The concept of ‘embolic stroke of undetermined source’ (ESUS) may facilitate the development of a standardized approach to diagnose cryptogenic stroke and improve clinical trials. Since recent large randomized control trials failed to demonstrate a reduction in stroke recurrence with anticoagulants, anti-platelet agents remain the first-line treatment for ESUS patients. Nevertheless, patients with high risk of stroke recurrence (e.g., those with repeated embolic infarcts despite aspirin treatment) require a more extensive survey of stroke etiology, including cardiac imaging and prolonged cardiac rhythm monitoring. Anticoagulant treatments may still benefit some subgroups of high-risk ESUS patients, such as those with multiple infarcts at different arterial territories without aortic atheroma, the elderly, or patients with high CHA2D2-VASc or HOVAC scores, atrial cardiopathy or patent foramen ovale. Several important ESUS clinical trials are ongoing, and the results are anticipated. With rapid progress in our understanding of ESUS pathophysiology, new subcategorizations of ESUS and assignment of optimal treatments for each ESUS subgroup are expected in the near future.http://www.sciencedirect.com/science/article/pii/S0929664620302163Cardiac rhythm monitorCryptogenic strokeESUSNOACTransesophageal echocardiography |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Li-Kai Tsai I-Hui Lee Yung-Lung Chen Tze-Fan Chao Yu-Wei Chen Helen L. Po Li-Ming Lien Pao-Hsien Chu Wei-Chun Huang Tsung-Hsien Lin Ming-Tai Lin Jiann-Shing Jeng Juey-Jen Hwang |
spellingShingle |
Li-Kai Tsai I-Hui Lee Yung-Lung Chen Tze-Fan Chao Yu-Wei Chen Helen L. Po Li-Ming Lien Pao-Hsien Chu Wei-Chun Huang Tsung-Hsien Lin Ming-Tai Lin Jiann-Shing Jeng Juey-Jen Hwang Diagnosis and Treatment for embolic stroke of undetermined source: Consensus statement from the Taiwan stroke society and Taiwan society of cardiology Journal of the Formosan Medical Association Cardiac rhythm monitor Cryptogenic stroke ESUS NOAC Transesophageal echocardiography |
author_facet |
Li-Kai Tsai I-Hui Lee Yung-Lung Chen Tze-Fan Chao Yu-Wei Chen Helen L. Po Li-Ming Lien Pao-Hsien Chu Wei-Chun Huang Tsung-Hsien Lin Ming-Tai Lin Jiann-Shing Jeng Juey-Jen Hwang |
author_sort |
Li-Kai Tsai |
title |
Diagnosis and Treatment for embolic stroke of undetermined source: Consensus statement from the Taiwan stroke society and Taiwan society of cardiology |
title_short |
Diagnosis and Treatment for embolic stroke of undetermined source: Consensus statement from the Taiwan stroke society and Taiwan society of cardiology |
title_full |
Diagnosis and Treatment for embolic stroke of undetermined source: Consensus statement from the Taiwan stroke society and Taiwan society of cardiology |
title_fullStr |
Diagnosis and Treatment for embolic stroke of undetermined source: Consensus statement from the Taiwan stroke society and Taiwan society of cardiology |
title_full_unstemmed |
Diagnosis and Treatment for embolic stroke of undetermined source: Consensus statement from the Taiwan stroke society and Taiwan society of cardiology |
title_sort |
diagnosis and treatment for embolic stroke of undetermined source: consensus statement from the taiwan stroke society and taiwan society of cardiology |
publisher |
Elsevier |
series |
Journal of the Formosan Medical Association |
issn |
0929-6646 |
publishDate |
2021-01-01 |
description |
Cryptogenic stroke comprises about one-quarter of ischemic strokes with high recurrence rate; however, studies specifically investigating the features and treatment of this stroke subtype are rare. The concept of ‘embolic stroke of undetermined source’ (ESUS) may facilitate the development of a standardized approach to diagnose cryptogenic stroke and improve clinical trials. Since recent large randomized control trials failed to demonstrate a reduction in stroke recurrence with anticoagulants, anti-platelet agents remain the first-line treatment for ESUS patients. Nevertheless, patients with high risk of stroke recurrence (e.g., those with repeated embolic infarcts despite aspirin treatment) require a more extensive survey of stroke etiology, including cardiac imaging and prolonged cardiac rhythm monitoring. Anticoagulant treatments may still benefit some subgroups of high-risk ESUS patients, such as those with multiple infarcts at different arterial territories without aortic atheroma, the elderly, or patients with high CHA2D2-VASc or HOVAC scores, atrial cardiopathy or patent foramen ovale. Several important ESUS clinical trials are ongoing, and the results are anticipated. With rapid progress in our understanding of ESUS pathophysiology, new subcategorizations of ESUS and assignment of optimal treatments for each ESUS subgroup are expected in the near future. |
topic |
Cardiac rhythm monitor Cryptogenic stroke ESUS NOAC Transesophageal echocardiography |
url |
http://www.sciencedirect.com/science/article/pii/S0929664620302163 |
work_keys_str_mv |
AT likaitsai diagnosisandtreatmentforembolicstrokeofundeterminedsourceconsensusstatementfromthetaiwanstrokesocietyandtaiwansocietyofcardiology AT ihuilee diagnosisandtreatmentforembolicstrokeofundeterminedsourceconsensusstatementfromthetaiwanstrokesocietyandtaiwansocietyofcardiology AT yunglungchen diagnosisandtreatmentforembolicstrokeofundeterminedsourceconsensusstatementfromthetaiwanstrokesocietyandtaiwansocietyofcardiology AT tzefanchao diagnosisandtreatmentforembolicstrokeofundeterminedsourceconsensusstatementfromthetaiwanstrokesocietyandtaiwansocietyofcardiology AT yuweichen diagnosisandtreatmentforembolicstrokeofundeterminedsourceconsensusstatementfromthetaiwanstrokesocietyandtaiwansocietyofcardiology AT helenlpo diagnosisandtreatmentforembolicstrokeofundeterminedsourceconsensusstatementfromthetaiwanstrokesocietyandtaiwansocietyofcardiology AT liminglien diagnosisandtreatmentforembolicstrokeofundeterminedsourceconsensusstatementfromthetaiwanstrokesocietyandtaiwansocietyofcardiology AT paohsienchu diagnosisandtreatmentforembolicstrokeofundeterminedsourceconsensusstatementfromthetaiwanstrokesocietyandtaiwansocietyofcardiology AT weichunhuang diagnosisandtreatmentforembolicstrokeofundeterminedsourceconsensusstatementfromthetaiwanstrokesocietyandtaiwansocietyofcardiology AT tsunghsienlin diagnosisandtreatmentforembolicstrokeofundeterminedsourceconsensusstatementfromthetaiwanstrokesocietyandtaiwansocietyofcardiology AT mingtailin diagnosisandtreatmentforembolicstrokeofundeterminedsourceconsensusstatementfromthetaiwanstrokesocietyandtaiwansocietyofcardiology AT jiannshingjeng diagnosisandtreatmentforembolicstrokeofundeterminedsourceconsensusstatementfromthetaiwanstrokesocietyandtaiwansocietyofcardiology AT jueyjenhwang diagnosisandtreatmentforembolicstrokeofundeterminedsourceconsensusstatementfromthetaiwanstrokesocietyandtaiwansocietyofcardiology |
_version_ |
1724414275734208512 |