Format

Send to

Choose Destination
See comment in PubMed Commons below
Lancet Neurol. 2014 Apr;13(4):429-38. doi: 10.1016/S1474-4422(13)70310-7.

Embolic strokes of undetermined source: the case for a new clinical construct.

Author information

1
McMaster University and Population Health Research Institute, Hamilton, ON, Canada. Electronic address: robert.hart@phri.ca.
2
University Duisburg-Essen, Essen, Germany.
3
University of Calgary, Calgary, AB, Canada.
4
Department of Neurology, University of California San Francisco, San Francisco, USA.
5
Duke University, Durham, NC, USA.
6
National University of Ireland Galway, Galway, Ireland.
7
Miller School of Medicine, University of Miami, Miami, FL, USA.
8
McMaster University and Population Health Research Institute, Hamilton, ON, Canada.

Abstract

Cryptogenic (of unknown cause) ischaemic strokes are now thought to comprise about 25% of all ischaemic strokes. Advances in imaging techniques and improved understanding of stroke pathophysiology have prompted a reassessment of cryptogenic stroke. There is persuasive evidence that most cryptogenic strokes are thromboembolic. The thrombus is thought to originate from any of several well established potential embolic sources, including minor-risk or covert cardiac sources, veins via paradoxical embolism, and non-occlusive atherosclerotic plaques in the aortic arch, cervical, or cerebral arteries. Accordingly, we propose that embolic strokes of undetermined source are a therapeutically relevant entity, which are defined as a non-lacunar brain infarct without proximal arterial stenosis or cardioembolic sources, with a clear indication for anticoagulation. Because emboli consist mainly of thrombus, anticoagulants are likely to reduce recurrent brain ischaemia more effectively than are antiplatelet drugs. Randomised trials testing direct-acting oral anticoagulants for secondary prevention of embolic strokes of undetermined source are warranted.

PMID:
24646875
DOI:
10.1016/S1474-4422(13)70310-7
[Indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science
    Loading ...
    Support Center