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J Neurol Sci. 2019 Jun 15;401:5-11. doi: 10.1016/j.jns.2019.04.008. Epub 2019 Apr 6.

Incidence, characteristics and outcomes in patients with embolic stroke of undetermined source: A population-based study.

Author information

1
Department of Neurology, University Hospital of Alexandroupolis, Democritus University of Thrace, School of Medicine, Alexandroupolis, Greece; Second Department of Neurology, "Attikon" Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece. Electronic address: tsivgoulisgiorg@yahoo.gr.
2
Stroke Unit, Metropolitan Hospital, Piraeus, Greece.
3
Second Department of Neurology, "Attikon" Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece; Department of Neurology, University of Ioannina, School of Medicine, Ioannina, Greece.
4
Department of Neurology, University Hospital of Alexandroupolis, Democritus University of Thrace, School of Medicine, Alexandroupolis, Greece.
5
Department of Primary Education, University of Ioannina, Ioannina, Greece.
6
Hypertension Excellence Center, 1st Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
7
Department of Neurosurgery, University Hospital of Alexandroupolis, Democritus University of Thrace, School of Medicine, Alexandroupolis, Greece.
8
Department of Radiology, University Hospital of Alexandroupolis, Democritus University of Thrace, School of Medicine, Alexandroupolis, Greece.
9
Second Department of Neurology, "Attikon" Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
10
Second Department of Internal Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, School of Medicine, Alexandroupolis, Greece.
11
First Department of Internal Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, School of Medicine, Alexandroupolis, Greece.
12
Department of Vascular Surgery, Democritus University of Thrace, School of Medicine, Alexandroupolis, Greece.
13
First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece.

Abstract

Embolic stroke of undetermined source (ESUS) represents a subgroup of cryptogenic ischemic stroke (CS) distinguished by high probability of an underlying embolic mechanism. There are scarce population-based data regarding the incidence, characteristics and outcomes of ESUS. Consecutive patients included with first-ever ischemic stroke of undetermined cause in the previously published population-based Evros Stroke Registry were further subdivided into ESUS and non-ESUS CS. Crude and adjusted [according to the European Standard Population (ESP), WHO and Segi population] incidence rates (IR) for ESUS and non-ESUS CS were calculated. Baseline characteristics, admission stroke severity (assessed using NIHSS-score), stroke recurrence and functional outcomes [determined by modified Rankin Scale (mRS) scores], were recorded during the 1-year follow-up period. We identified 21 and 242 cases with ESUS (8% of CS) and non-ESUS CS. The crude and ESP-adjusted IR for ESUS were 17.5 (95%CI: 10-25) and 16.6 (95%CI: 10-24) per 100,000 person-years. Patients with ESUS were younger (p < .001) and had lower median admission NIHSS-scores (p < .001). Functional outcomes were more favorable in ESUS at 28, 90 and 365 days. ESUS was independently (p = .033) associated with lower admission NIHSS-scores (unstandardized linear regression coefficient: -13.34;95%CI: -23.34, -3.35) on multiple linear regression models. ESUS was not related to 1-year stroke recurrence, mortality and functional improvement on multivariable analyses. In conclusion we found that ESUS cases represented 8% of CS patients in this population-based study. Despite the fact that ESUS was independently related to lower admission stroke severity, there was no association of ESUS with long-term outcomes.

KEYWORDS:

Anticoagulation; Atrial fibrillation; Cryptogenic stroke; Embolic stroke of undetermined source; Incidence rate; Mortality; Population-based; Recurrence

PMID:
30986703
DOI:
10.1016/j.jns.2019.04.008

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